What is the recommended treatment for asthma using prednisolone (corticosteroid)?

From the Guidelines

Prednisolone is recommended as a short-term treatment for acute asthma exacerbations, with a typical dosage of 40-60mg orally once daily for 5-7 days in adults and 1-2mg/kg/day (maximum 40mg) in children. The treatment of asthma exacerbations with prednisolone is supported by the National Asthma Education and Prevention Program Expert Panel report 3 guidelines for the management of asthma exacerbations 1. Key points to consider when prescribing prednisolone for asthma include:

• The dose and duration of treatment should be based on the severity of the exacerbation and the patient's response to treatment.
• Patients should be monitored closely for signs of improvement or worsening of symptoms, and treatment should be adjusted accordingly.
• Prednisolone should be taken in the morning with food to minimize gastrointestinal side effects and reduce disruption to the body's natural cortisol production.
• Patients should continue their regular controller medications and rescue inhalers as prescribed while taking prednisolone.
• Common side effects of prednisolone include increased appetite, mood changes, and difficulty sleeping, but these typically resolve after completing the short course.
• If symptoms worsen or don't improve after 2-3 days of treatment, medical attention should be sought immediately 1. It's also important to note that the use of systemic corticosteroids, such as prednisolone, is a key component of asthma management, and the frequency and duration of use can be an indicator of asthma control 1.

From the FDA Drug Label

The National Heart, Lung, and Blood Institute (NHLBI) recommended dosing for systemic prednisone, prednisolone or methylprednisolone in children whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators is 1–2 mg/kg/day in single or divided doses It is further recommended that short course, or "burst" therapy, be continued until a child achieves a peak expiratory flow rate of 80% of his or her personal best or symptoms resolve. This usually requires 3 to 10 days of treatment, although it can take longer.

The recommended treatment for asthma using prednisolone is 1-2 mg/kg/day in single or divided doses, as recommended by the National Heart, Lung, and Blood Institute (NHLBI) for children whose asthma is uncontrolled by inhaled corticosteroids and long-acting bronchodilators. The treatment should be continued until the patient achieves a peak expiratory flow rate of 80% of their personal best or symptoms resolve, which usually requires 3 to 10 days of treatment 2.

• The dosage may vary depending on the patient's response and clinical status.
• Short-course therapy is recommended, and there is no evidence that tapering the dose after improvement will prevent a relapse.

From the Research

Recommended Treatment for Asthma using Prednisolone

The recommended treatment for asthma using prednisolone (corticosteroid) can vary depending on the severity of the asthma exacerbation.

• For acute exacerbations of asthma not considered severe enough for admission to hospital but requiring treatment with oral corticosteroid, a short reducing course of oral prednisolone (starting at 40 mg/day and reducing by 5 mg every other day) is as effective as a high dose of inhaled fluticasone propionate (2 mg daily) 3.
• A dose response study showed that a minimum dose of 0.6 mg prednisolone/kg body weight for a period up to two weeks is effective in treating exacerbations of asthma not requiring admission to hospital 4.
• The optimal duration of oral steroid treatment in acute adult asthma is unclear, but a study suggests that 5 days of oral prednisolone may be sufficient, provided all patients receive inhaled steroids and a personal asthma management plan 5.
• Steroid tapering may be unnecessary in acute asthma, and a personal asthma management plan with a reserve course of prednisolone may be more appropriate 6.
• Low doses of corticosteroids, such as hydrocortisone 50 mg intravenously four times a day for two days followed by low dose oral prednisone, can be as effective in resolving acute severe asthma as higher doses 7.

Key Considerations

• The dose and duration of prednisolone treatment should be individualized based on the severity of the asthma exacerbation and the patient's response to treatment.
• Inhaled corticosteroids and a personal asthma management plan should be used in conjunction with oral prednisolone to manage asthma exacerbations.
• The effectiveness of prednisolone treatment can be monitored by measuring peak expiratory flow (PEF) and forced expiratory volume in one second (FEV1), as well as by assessing symptoms and quality of life.