Recommended Dosage of Prednisone for Asthma Exacerbation
For adults with asthma exacerbation, the recommended dose of prednisone is 40-60 mg daily for 5-10 days. For children, the dose is 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days. 1
Adult Dosing Protocol
Initial Dosing
- Dose: 40-80 mg/day (typically 40-60 mg)
- Frequency: Single daily dose or divided into two doses
- Duration: Continue until peak expiratory flow (PEF) reaches 70% of predicted or personal best, typically 5-10 days 1
Administration Considerations
- Oral administration is preferred and equally effective as intravenous administration 1
- No need to taper the dose for short courses (less than 7 days) 1
- For courses up to 10 days, tapering is generally unnecessary, especially if patients are concurrently taking inhaled corticosteroids 1
Pediatric Dosing Protocol
Initial Dosing
- Dose: 1-2 mg/kg/day
- Maximum dose: 60 mg/day
- Duration: 3-10 days 1
Age-Specific Considerations
- For children under 12 years: 1-2 mg/kg in 2 divided doses (maximum 60 mg/day) 1
- Recent evidence suggests that 1 mg/kg/day is as effective as 2 mg/kg/day for moderate exacerbations in children 1-5 years old, with fewer side effects like vomiting 2
Clinical Decision Points
When to Initiate Treatment
Indications for systemic corticosteroids include:
- Progressive worsening of symptoms day by day
- PEF falls below 60% of patient's best
- Sleep disturbance due to asthma
- Morning symptoms persisting until midday
- Diminishing response to inhaled bronchodilators
- Emergency use of nebulized or injected bronchodilators 1
Duration of Treatment
- Continue treatment until lung function values return to previous best 1
- While 7 days is often sufficient, treatment may need to be continued for up to 21 days in some cases 1
- Recent evidence suggests that 5 days may be sufficient for adults who are also receiving inhaled corticosteroids and have a personal asthma management plan 3
Important Clinical Considerations
Efficacy
- There is no known advantage for higher doses of corticosteroids in severe asthma exacerbations 1
- Low-dose hydrocortisone (equivalent to lower prednisone doses) has been shown to be as effective as higher doses in resolving acute severe asthma 4
Side Effects and Monitoring
- Short courses of systemic corticosteroids generally have minimal impact on the hypothalamic-pituitary-adrenal axis, though patients receiving 4 or more courses per year may show suppression 5
- Monitor for common side effects including hyperglycemia, mood changes, and insomnia
- Gastrointestinal bleeding risk is very low with short-term use, with greatest risk in patients with history of GI bleeding or those taking anticoagulants 1
Adjunctive Therapy
- Inhaled corticosteroids can be started at any point during treatment of an asthma exacerbation 1
- Continue appropriate bronchodilator therapy (e.g., short-acting beta-agonists) during the course of systemic corticosteroids 1
By following these evidence-based dosing guidelines, clinicians can effectively manage asthma exacerbations while minimizing potential side effects from systemic corticosteroid therapy.