From the Guidelines
Prednisone dosing for wheezing should be 40-60 mg/day in 1 or 2 divided doses until symptoms improve.
Key Considerations
- The dose may need to be adjusted based on the severity of the exacerbation and the patient's response to treatment 1.
- Treatment should continue until peak expiratory flow (PEF) reaches 70% of predicted or personal best, or for a total of 5-10 days in adults 1.
- In children, the dose is 1-2 mg/kg/day, with a maximum of 60 mg/day, for 3-10 days 1.
- Systemic corticosteroids, such as prednisone, are effective for acute asthma exacerbations and should be administered early to hasten the resolution of airflow obstruction and reduce hospital admissions 1.
- The choice of corticosteroid and dosing regimen may depend on the individual patient's needs and medical history, as well as the severity of the exacerbation 1.
Dosing Regimens
- A typical dosing regimen for prednisone is 40-60 mg/day in 1 or 2 divided doses, with treatment continuing for 5-10 days in adults 1.
- In children, the dose is 1-2 mg/kg/day, with a maximum of 60 mg/day, for 3-10 days 1.
- The dose may need to be adjusted based on the severity of the exacerbation and the patient's response to treatment 1.
From the Research
Dosing of Prednisone for Wheezing
- The appropriate dosing of Prednisone for wheezing is not explicitly stated in the provided studies, but some studies suggest the following doses:
- A 5-day course of oral prednisolone (10 mg once a day for children 10 to 24 months of age and 20 mg once a day for older children) was used in a study of preschool children with acute virus-induced wheezing 2
- A dose of 2 mg/kg, followed by 2 mg/kg/d in 2 divided doses for 3 days was used in a study of young children with a first acute, moderate-to-severe, rhinovirus-induced wheezing episode 3
- The efficacy of these doses is not consistent across studies, with some studies showing no significant difference between prednisolone and placebo in terms of duration of hospitalization or secondary outcomes 2, while others suggest that prednisolone may be beneficial in certain subgroups, such as children with high viral loads 3
- A study comparing intramuscular dexamethasone to oral prednisone for children with mild to moderate wheezing episodes found that the two treatments were equivalent in terms of symptomatic improvement, but did not provide specific dosing information for prednisone 4
- Another study found that hydrocortisone 50 mg intravenously four times a day for two days followed by low dose oral prednisone was as effective as higher doses of hydrocortisone followed by higher doses of prednisone in resolving acute severe asthma 5
Considerations for Dosing
- The dose of prednisone used may depend on the severity of the wheezing episode, as well as the age and weight of the child
- The duration of treatment may also vary, with some studies using a 5-day course of prednisolone 2 and others using a 3-day course 3
- The use of prednisone in children with wheezing should be guided by clinical judgment and consideration of the potential benefits and risks of treatment, as well as the results of studies such as those cited here 4, 6, 5, 2, 3