Is 7.5ml twice daily of prednisolone (corticosteroid) solution appropriate for a 5-year-old child with asthma?

From the Guidelines

I strongly advise against using 7.5ml twice daily of prednisolone solution in a 5-year-old child with asthma without knowing the concentration of the solution and the child's weight. Prednisolone dosing for children with asthma exacerbations typically ranges from 1-2 mg/kg/day, usually given once daily or divided twice daily 1. The appropriate dose depends on the severity of the asthma attack, the child's weight, and their previous response to treatment. For a 5-year-old child weighing approximately 18-20 kg, the total daily dose might range from 18-40 mg depending on severity, but this must be determined by a healthcare provider.

Key Considerations

• The dose of prednisolone should be individualized based on the child's response to treatment and potential side effects, such as mood changes, increased appetite, and immune suppression when used long-term 1.
• Short courses (3-5 days) of prednisolone are often used for asthma flares to reduce airway inflammation, and parents should always follow the prescribing physician's instructions, never adjust dosing without medical guidance, and report any concerning side effects promptly.
• According to the expert panel report 3 (epr-3): guidelines for the diagnosis and management of asthma-summary report 2007, the need for step 4 care usually involves children who have a low level of lung function contributing to their impairment, and the combination of ICS and LABA is preferred 1.

Monitoring and Adjustments

• Monitor asthma progression, as declines in lung function or repeated periods of worsening asthma impairment may indicate a progressive worsening of the underlying severity of asthma 1.
• Adjustments in treatment may be necessary to maintain asthma control, and a careful review for other pulmonary conditions or comorbid conditions should be conducted to ensure that the primary diagnosis is severe asthma 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

• For a 5-year-old child, the recommended dose is 1-2 mg/kg/day.
• To determine if 7.5ml twice daily is appropriate, we need to calculate the dose in mg/kg/day.
• Since 5 mL of prednisolone sodium phosphate oral solution is equivalent to 15 mg prednisolone, 7.5ml is equivalent to 22.5 mg prednisolone.
• Assuming a typical weight for a 5-year-old child is around 18-20 kg, the dose would be approximately 2.25-2.5 mg/kg/day for 7.5ml twice daily (or 4.5-5 mg/kg/day), which is higher than the recommended dose.
• Therefore, 7.5ml twice daily of prednisolone solution may be too high for a 5-year-old child with asthma, and the dose should be adjusted according to the child's response and weight 2.

From the Research

Dosage of Prednisolone for a 5-year-old Child with Asthma

• The appropriate dosage of prednisolone for a 5-year-old child with asthma is not directly stated in the provided studies, but we can look at the dosages used in similar contexts.
• A study from 2021 3 compared the clinical outcomes and side effect profile between 1 mg/kg/day and 2 mg/kg/day of oral prednisolone in preschool children with acute moderate asthma exacerbations.
• The study found that prednisolone at a dose of 1 mg/kg/day was not inferior to 2 mg/kg/day in terms of clinical improvement and recurrence of wheeze within 1 week, and had less frequent vomiting compared to the higher dose.
• For a 5-year-old child, assuming an average weight of around 18-20 kg, the dosage of 1 mg/kg/day would translate to approximately 18-20 mg per day, which is higher than the 7.5ml twice daily (assuming 7.5ml = 7.5mg, which may not be the case as the concentration of the solution is not provided) mentioned in the question.
• Another study from 1998 4 compared the effectiveness and safety of inhaled corticosteroids with oral prednisolone in controlling acute asthma attacks in children, but did not provide information on the dosage of prednisolone for a 5-year-old child.

Considerations for Dosage

• The dosage of prednisolone for a child with asthma should be determined by a healthcare professional, taking into account the child's age, weight, and severity of symptoms.
• It is also important to consider the potential side effects of prednisolone, such as vomiting, and to monitor the child's response to treatment.
• Inhaled corticosteroids may be a viable alternative to oral prednisolone for long-term asthma control in children, as they have been shown to be effective in reducing symptoms and improving lung function 4, 5.
• However, the use of inhaled corticosteroids in children under 5 years old is still a topic of debate, and more research is needed to determine their safety and effectiveness in this age group 5.