From the Guidelines
The typical dose of oral steroids for asthma exacerbations is prednisone 40-60 mg once daily for 5-10 days in adults, with no taper needed for short courses, as recommended by the most recent guidelines 1.
Key Considerations
- For children, the recommended dose is 1-2 mg/kg/day of prednisone or prednisolone (maximum 60 mg/day) for 3-10 days 1.
- Oral steroids work by reducing inflammation in the airways, decreasing mucus production, and improving airflow.
- They should be started promptly during moderate to severe exacerbations to prevent worsening symptoms and potential hospitalization.
- Common side effects include increased appetite, mood changes, insomnia, and elevated blood glucose, though these are typically minimal with short courses.
- Patients should take the medication in the morning with food to minimize gastrointestinal upset and sleep disturbances.
Important Notes
- Long-term or frequent use of oral steroids should be avoided due to serious side effects like osteoporosis, adrenal suppression, and increased infection risk.
- If a patient requires frequent steroid bursts, their maintenance asthma therapy should be reassessed.
- The dose and duration of oral steroids may vary depending on the individual patient's response to therapy and the severity of the exacerbation, as noted in other guidelines 1.
Clinical Decision Making
- The decision to use oral steroids should be based on the patient's clinical presentation and the severity of the exacerbation.
- The patient's response to therapy should be closely monitored, and adjustments made as needed to minimize side effects and optimize outcomes.
- Other guidelines, such as those from the Journal of Allergy and Clinical Immunology 1 and the NAEPP expert panel report 1, provide additional information on the use of oral steroids in asthma management, but the most recent and highest quality study 1 should be prioritized.
From the Research
Dose of Oral Corticosteroids for Asthma
- The dose of oral corticosteroids for asthma exacerbations is not well established, with varying guidelines and practices among different countries and healthcare providers 2.
- A study comparing different oral corticosteroid regimens for acute asthma found no convincing evidence of differences in outcomes between higher and lower doses, or between longer and shorter courses of treatment 2.
- Another study found that low-dose 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 and prednisone in resolving acute severe asthma 3.
- A survey of physicians' practice patterns for oral corticosteroid burst therapy in outpatient management of acute asthma exacerbations found that the majority prescribed a total burst dose of ≤200 mg for patients ≥12 years of age, and ≤1 mg/kg per day for 3 days for younger children 4.
- The use of oral corticosteroids in acute asthma is recommended to promote recovery, but the optimal dose and duration of treatment are still unclear 5, 6.
Specific Dosing Regimens
- One study found that a fixed single daily dose of oral corticosteroids was the most commonly prescribed regimen (59%) 4.
- Another study compared the effectiveness of low-dose (50 mg) and high-dose (500 mg) hydrocortisone, followed by oral prednisone, and found no significant difference in outcomes 3.
- The majority of physicians surveyed prescribed a total burst dose of ≤600 mg for patients ≥12 years of age, and ≤2 mg/kg per day for 10 days for younger children 4.
Limitations and Future Directions
- The evidence for optimal dosing of oral corticosteroids for asthma exacerbations is limited, and further studies are needed to determine the most effective and safe treatment regimens 2, 4.
- The use of oral corticosteroids in acute asthma should be balanced against the potential for adverse events, and healthcare providers should consider individual patient factors when determining the optimal dose and duration of treatment 2, 5.