What corticosteroid is recommended for managing an asthma exacerbation in the context of influenza (flu)?

Corticosteroid Selection for Asthma Exacerbation with Influenza

Oral prednisone (40-60 mg daily for 5 days) is the recommended corticosteroid for managing asthma exacerbations in the context of influenza. 1, 2

Rationale for Oral Prednisone

• The National Asthma Education and Prevention Program (NAEPP) Expert Panel recommends oral administration of prednisone for asthma exacerbations, which has been shown to have effects equivalent to intravenous methylprednisolone but is less invasive 1
• The American Academy of Allergy, Asthma, and Immunology specifically recommends a fixed dose of 40-60 mg daily of prednisone for adults for a 5-day course to treat an asthma exacerbation 2
• No tapering is required for short courses (5 days) of prednisone, which simplifies treatment 2

Dosing Guidelines

For Adults:

• 40-60 mg daily in a single dose or divided into 2 doses for 5 days 2
• No tapering required for courses less than 7 days 2

For Children:

• 1-2 mg/kg/day (maximum 60 mg/day) for 5 days 2, 3
• No tapering required 2

Route of Administration

• Oral administration is preferred over intravenous when gastrointestinal absorption is not impaired 2
• Multiple studies have demonstrated that oral corticosteroids are as effective as intravenous corticosteroids for asthma exacerbations 4, 5
• Oral administration is more cost-effective than intravenous administration 4

Alternative Options

• Dexamethasone (0.3 to 0.6 mg/kg daily) may be considered as an alternative in pediatric patients 3, 6
• Two doses of dexamethasone may be as effective as a 5-day course of prednisone/prednisolone for pediatric asthma exacerbations 6
• However, prednisone remains the first-line recommendation based on extensive clinical experience and guideline recommendations 1, 2

Important Clinical Considerations

• Systemic corticosteroids should be administered to all patients with moderate-to-severe exacerbations and to those who do not respond to initial β2-agonist therapy 1
• Early administration of corticosteroid therapy might reduce the likelihood of hospitalization in patients with moderate-to-severe exacerbations 1
• Inhaled corticosteroids are not recommended over oral corticosteroids for acute treatment in the emergency department 1
• Patients who regularly take corticosteroids should receive supplemental doses even if the exacerbation is mild 1

Treatment Duration

• Treatment should continue until peak expiratory flow (PEF) reaches 70% of predicted or personal best 2
• Before discharge, patients should be prescribed sufficient medication to continue therapy for 3 to 10 days 1

Monitoring

• Monitor for symptom control, lung function, and medication side effects 2
• Patients should be provided with a follow-up appointment to evaluate the need for additional corticosteroid treatment 1

Remember that in the context of influenza, treating the asthma exacerbation with systemic corticosteroids remains the priority to prevent respiratory deterioration, despite the presence of viral infection.