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

From the Guidelines

Prednisolone is recommended for treating acute asthma exacerbations at a dose of 60 mg/day for 3-10 days in adults, and 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days in children. This recommendation is based on the most recent and highest quality study available, which suggests that there is no advantage to higher doses of corticosteroids in severe asthma exacerbations, and that oral therapy is just as effective as intravenous administration 1.

Key Considerations

• The dose and duration of prednisolone treatment should be individualized based on the patient's response to therapy and the severity of their asthma exacerbation.
• Patients should continue their regular asthma medications, including inhaled corticosteroids and bronchodilators, while taking prednisolone.
• Common side effects of prednisolone include increased appetite, mood changes, and sleep disturbances, but these are typically temporary with short courses.
• Patients should contact their healthcare provider if symptoms worsen or don't improve after 2-3 days of treatment.

Additional Guidance

• The Expert Panel Report 3 (EPR-3) guidelines suggest that a short course of oral systemic corticosteroids, such as prednisolone, may be considered to gain more rapid control for patients whose asthma frequently interrupts sleep or normal daily activities, or who are experiencing an exacerbation at the time of assessment 1.
• The guidelines also recommend that patients be closely monitored after discontinuing therapy, and that a step down in therapy be considered once asthma is well controlled for at least 3 months 1.
• Another study suggests that there is no need to taper the dose of systemic corticosteroids for courses of less than 1 week, and that therapy following a hospitalization or emergency department visit may last from 3 to 10 days 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

• The recommended treatment for asthma with 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.
• This dose should be continued until the patient achieves a peak expiratory flow rate of 80% of his or her personal best or symptoms resolve, which usually requires 3 to 10 days of treatment 2.

From the Research

Recommended Treatment for Asthma with Prednisolone

• The recommended treatment for asthma with prednisolone (corticosteroid) varies depending on the severity of the asthma exacerbation 3, 4, 5.
• For acute exacerbations of asthma, oral corticosteroids such as prednisolone are recommended for all but the most mild cases 4.
• A short course of oral prednisolone, starting at 40 mg/day and reducing by 5 mg every other day, is commonly used to treat acute exacerbations of asthma 3.
• High-dose inhaled corticosteroids, such as fluticasone propionate, may be as effective as oral prednisolone in controlling mild to moderate asthma exacerbations 3.
• The dose response of patients to oral corticosteroid treatment during exacerbations of asthma shows that a higher dose of prednisolone (0.6 mg/kg body weight daily) is more effective than lower doses (0.2 and 0.4 mg/kg body weight daily) 5.

Comparison of Oral Corticosteroid Regimens

• There is no convincing evidence of differences in outcomes between a higher dose or longer course and a lower dose or shorter course of prednisolone or dexamethasone, or between prednisolone and dexamethasone 4.
• A single dose of oral dexamethasone (0.3 mg/kg) may be clinically non-inferior to prednisolone (1 mg/kg/day for three days) in the treatment of exacerbations of asthma in children 6.
• Oral prednisolone is the treatment of choice for the most severe asthma exacerbations, given together with oxygen and beta-2 agonists 7.

Treatment of Acute Asthma Attack

• Oxygen is the first treatment needed to overcome hypoxemia, followed by beta-2 agonists and oral prednisolone for severe exacerbations 7.
• High-dose inhaled corticosteroids are at least as effective as oral corticosteroids in controlling moderate-to-severe asthma attacks, especially in children 7.