What is the appropriate dosage of prednisolone for a 5-year-old child with asthma taking 90mg per day?

From the Guidelines

A 90mg daily dose of prednisolone is excessively high for a 5-year-old child with asthma and should be immediately reviewed by a healthcare provider. The appropriate dosage for acute asthma exacerbations in children is typically 1-2 mg/kg/day, with a usual maximum of 40-60mg per day, as recommended by the Expert Panel Report 3 (EPR-3) guidelines for the diagnosis and management of asthma 1. For a typical 5-year-old weighing approximately 18-20kg, this would translate to roughly 20-40mg daily, divided into 1-2 doses for 3-5 days.

Key Considerations

• The dosage of prednisolone should be carefully calibrated to balance therapeutic benefit against potential harm, especially in young children whose developing bodies are more vulnerable to steroid side effects 1.
• Potential side effects of high-dose prednisolone include growth suppression, immunosuppression, mood changes, and metabolic disturbances.
• Regular follow-up contact is essential to monitor the child's response to treatment and adjust the dosage as needed to maintain control of asthma while minimizing side effects.

Recommendations

• The child's current dosage of 15ml twice daily of 15mg/5ml solution, which equals 90mg per day, should be reduced to a more appropriate dose for their age and weight.
• A healthcare provider should review the child's treatment plan and consider alternative dosing regimens, such as 1-2 mg/kg/day, to ensure the child receives the appropriate amount of medication to control their asthma symptoms while minimizing potential side effects.

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 patient is 5 years old and is receiving 15ml twice daily of 15mg/5ml solution, which is equivalent to 90mg per day (15mg/5ml * 15ml * 2).
• The recommended dosage for a child with asthma is 1-2 mg/kg/day.
• Assuming an average weight of 18-20 kg for a 5-year-old child, the recommended dosage would be 18-40 mg per day.
• The patient's current dosage of 90mg per day is higher than the recommended dosage.
• Caution is advised, as high doses of prednisolone can have significant side effects, especially in pediatric patients.
• The dosage should be individualized and adjusted based on the patient's response and clinical status 2.

From the Research

Dosage Calculation

• The patient is receiving 15ml twice daily of a 15mg/5ml solution, which is equivalent to 15mg/5ml * 15ml = 45mg per dose.
• Since the patient is taking this dose twice daily, the total daily dose is 45mg * 2 = 90mg per day.

Comparison with Recommended Dosage

• According to the study 3, a dose of 1 mg/kg/day of oral prednisolone is not inferior to 2 mg/kg/day in terms of clinical improvement and recurrence of wheeze within 1 week for preschool children with acute moderate asthma exacerbations.
• Assuming an average weight of 20kg for a 5-year-old child, the recommended dose would be 1 mg/kg/day * 20kg = 20mg per day.
• The patient's current dose of 90mg per day is significantly higher than the recommended dose.

Potential Risks

• The study 4 found that an increased risk of fractures is associated with the use of more than 2.5mg of prednisolone or equivalent orally per day.
• The patient's current dose of 90mg per day is well above this threshold, which may increase the risk of fractures.
• The study 5 also mentions that long-term use of oral corticosteroids is associated with a variety of well-established toxic effects, including suppression of the hypothalamic-pituitary-adrenal axis.

Alternative Treatment Options

• The study 5 suggests that inhaled beclomethasone dipropionate may be an alternative to oral prednisone for long-term corticosteroid therapy in children with chronic asthma.
• However, the study 6 found that oral and intravenous steroids have similar efficacy in the treatment of adults hospitalized with acute exacerbation of bronchial asthma.