At what symptoms should oral steroids be administered?

Flow Chart for Oral Steroid Administration Based on Symptoms

Oral steroids should be administered when patients experience high fever and feel unwell, as early administration may prevent deterioration of the patient's condition, particularly in respiratory infections like COVID-19. 1

Respiratory Conditions

Asthma

• Mild Symptoms (PEF ≥80% of predicted/personal best)

  • No oral steroids needed
  • Use inhaled bronchodilators as needed

• Moderate Symptoms (PEF 50-79% of predicted/personal best)

  • Consider short course of oral steroids if not responding to inhaled therapy
  • Symptoms include: worsening shortness of breath, limited activity

• Severe Symptoms (PEF <50% of predicted/personal best) 2

  • Administer oral steroids immediately
  • Symptoms include: significant limitation of activities, inability to speak in full sentences
  • Prednisolone 30-60 mg orally or equivalent 2

• Life-threatening Symptoms (PEF <25% of predicted/personal best)

  • Immediate oral or IV steroids required
  • Symptoms include: cyanosis, inability to speak, altered consciousness

COVID-19

• Early Disease with High Fever and Malaise

  • Start oral steroids early 1
  • Methylprednisolone 1-2 mg per kg body weight for 3-5 days 1

• Progressing to Severe Disease

  • Continue oral steroids
  • Consider increasing dose if oxygen saturation decreases 1

Allergic Conditions

Allergic Rhinitis

• Mild to Moderate Symptoms

  • No oral steroids needed
  • Use intranasal corticosteroids and antihistamines 1

• Severe Symptoms Not Controlled with Other Treatments

  • Short course of oral glucocorticosteroids recommended 1
  • Symptoms include: severe nasal congestion, severe ocular symptoms

Dry Eye Disease

• Step 1-3 Disease

  • No oral steroids needed
  • Use topical treatments 1

• Step 4 Disease

  • Consider stronger potency steroids
  • Symptoms include: severe corneal epithelial defects, autoimmune disease 1

General Guidelines for Oral Steroid Use

1. Duration:

   • Short courses (5-7 days) generally do not require tapering 1
   • Can be stopped from full dosage without tapering when used for short periods 1

2. Dosing:

   • Prednisone 7.5-10 mg/day appears equivalent to moderate-high dose inhaled corticosteroids 3
   • For acute exacerbations: prednisolone 30-60 mg daily or equivalent 2

3. Contraindications:

   • Avoid recurrent parenteral corticosteroid administration 1
   • Intramuscular administration is not recommended for allergic rhinitis 1

Important Considerations

• Oral steroids should be used for the shortest duration possible to minimize adverse effects 4
• Monitor for side effects even with short courses
• Early administration of oral steroids in severe conditions may prevent progression to more serious disease 1
• For chronic conditions, consider steroid-sparing agents for long-term management 5

This flow chart prioritizes the early use of oral steroids in conditions where they can significantly reduce morbidity and mortality, particularly in respiratory infections with high fever and malaise, and severe asthma exacerbations.