From the Guidelines
For acute asthma exacerbations, a short course of oral corticosteroids is highly effective, with a recommended duration of 3 to 10 days, as stated in the guidelines by the National Asthma Education and Prevention Program Expert Panel 1.
Key Recommendations
- The standard dose of oral corticosteroids is 40-60 mg daily (or 1-2 mg/kg/day for children, maximum 60 mg) for 5-7 days, as suggested by the guidelines 1.
- Alternatively, dexamethasone can be given as 12 mg on day 1 followed by 8 mg on day 2 (or 0.6 mg/kg/day for 1-2 days in children), which may improve compliance due to its longer half-life and shorter course.
- There is no known advantage for higher doses of corticosteroids in severe asthma exacerbations, nor is there any advantage for intravenous administration over oral therapy provided gastrointestinal transit time or absorption is not impaired 1.
- For corticosteroid courses of less than 1 week, there is no need to taper the dose, and for slightly longer courses (e.g., up to 10 days), there probably is no need to taper, especially if patients are concurrently taking inhaled corticosteroids (ICSs) 1.
Mechanism and Side Effects
- Oral steroids work by reducing airway inflammation, decreasing mucus production, and enhancing bronchodilator responsiveness.
- Potential short-term side effects include increased appetite, mood changes, and elevated blood glucose, particularly in diabetic patients who may need closer glucose monitoring.
Clinical Considerations
- Patients should continue their regular controller medications during and after the steroid course, and follow up with their provider after completing treatment to assess response and adjust maintenance therapy if needed.
- Early administration of oral steroids, ideally within the first hour of treatment, leads to fewer hospitalizations and relapses.
- The guidelines emphasize the importance of prompt treatment and close monitoring of patients with acute asthma exacerbations, with consideration of special circumstances such as pregnancy and pediatric patients 1.
From the Research
Efficacy of Oral Corticosteroids for Acute Asthma Exacerbation
- The efficacy of oral corticosteroids for acute asthma exacerbation has been established, with studies showing that they accelerate the resolution of acute asthma and reduce the risk of relapse 2.
- A study comparing oral prednisolone and inhaled fluticasone propionate found that both treatments were equally effective in treating mild exacerbations of asthma 3.
- Another study found that oral and intravenous corticosteroids had similar efficacy in treating adults hospitalized with acute exacerbation of bronchial asthma 4.
Duration of Oral Corticosteroids Therapy
- The optimal duration of oral corticosteroids therapy for acute asthma exacerbation is not well established, with studies suggesting that a nontapered 5- to 10-day course may be sufficient for most discharged patients 2.
- A review of 18 studies found that there was 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 5.
- A study found that a short course of oral corticosteroids (starting at 40 mg/day and reducing by 5 mg every other day) was as effective as a high dose of inhaled fluticasone propionate in treating acute exacerbations of asthma 3.
Safety of Oral Corticosteroids
- Oral corticosteroids are generally considered safe for short-term use, with adverse effects rarely associated with short courses of steroids used for acute asthma exacerbations 6.
- However, long-term use of oral corticosteroids can be associated with a variety of well-established toxic effects, and the safe and effective use of oral corticosteroids requires careful consideration of the benefits and risks 6.
- A study found that oral and intravenous corticosteroids had similar safety profiles, with no significant differences in adverse events reported 4.