What is the typical dosing for Prednisone (corticosteroid) for cough and wheezing?

Prednisone Dosing for Cough and Wheezing

For severe paroxysms of cough and wheezing, prednisone should be prescribed at 30-40 mg daily for a short, finite period (typically 1-2 weeks), followed by a taper over 2-3 weeks. 1

Dosing Based on Underlying Cause

Asthma-Related Cough

• For cough variant asthma that is severe or only partially responsive to inhaled corticosteroids, oral prednisone 40 mg daily for 1 week is recommended 1
• Complete resolution of asthma-related cough typically occurs within 2-7 days of treatment 1
• After the initial course, transition to inhaled corticosteroids for maintenance therapy 1

Post-Infectious Cough

• For severe paroxysms of post-infectious cough, prednisone 30-40 mg daily for a short, finite period is recommended 1, 2
• This should be considered only after ruling out other common causes of cough (upper airway cough syndrome, asthma, gastroesophageal reflux disease) 1, 2
• Taper prednisone to zero over 2-3 weeks 1

Non-Specific Cough in Children

• For children with non-specific cough where asthma is suspected, a short (2-4 weeks) trial of inhaled corticosteroids equivalent to 400 mg/day of beclomethasone may be warranted 1
• Oral steroids should be reserved for more severe cases in children 1, 3
• In pediatric asthma exacerbations, prednisone dosing is 1-2 mg/kg daily for 5 days 3

Treatment Algorithm

1. First-Line Therapy:

   • For mild to moderate cough and wheezing: Try inhaled bronchodilators and inhaled corticosteroids first 1, 2
   • For post-infectious cough: Consider inhaled ipratropium bromide as first-line therapy 1, 2

2. Second-Line Therapy:

   • For cough that persists despite inhaled therapy: Consider inhaled corticosteroids if not already tried 1
   • For eosinophilic bronchitis: Inhaled corticosteroids are typically effective 1

3. When to Use Oral Prednisone:

   • Severe paroxysmal cough affecting quality of life 1
   • Cough refractory to inhaled medications 1
   • Evidence of airway eosinophilia (if testing available) 1, 4

4. Prednisone Dosing Protocol:

   • Starting dose: 30-40 mg daily 1
   • Duration: Short course of 1-2 weeks 1, 5
   • Taper: Gradually reduce dose over 2-3 weeks 1

Important Considerations and Pitfalls

• Verify the underlying cause of cough before initiating prednisone therapy, as inappropriate use may delay proper diagnosis 1, 2
• Inhaled corticosteroids may themselves induce or exacerbate cough in some patients due to components of the aerosol dispersant 1
• Low-dose prednisone (5 mg daily) has not shown benefit in chronic airway obstruction without asthmatic features 6
• Patients with sputum eosinophilia show better response to prednisone compared to those with non-eosinophilic inflammation 4
• Antibiotics have no role in treating post-infectious cough unless there is confirmed bacterial infection 1, 2
• If cough persists beyond 8 weeks despite appropriate therapy, reclassify as chronic cough and re-evaluate 2

Special Situations

• Giant Cell Arteritis: Prednisone 40-60 mg daily is recommended for cough associated with giant cell arteritis 1
• Allergic Bronchopulmonary Aspergillosis: Prednisone 0.5 mg/kg daily for 1 week, followed by alternate-day dosing, with attempt to discontinue after 6 weeks 1
• Pertussis (Whooping Cough): Requires specific antibiotic therapy rather than corticosteroids 1

Remember to reassess patients after 2-4 weeks of therapy to evaluate response and consider alternative diagnoses if cough persists 1, 2.