Prednisolone Dosing for Bronchial Asthma Exacerbation According to Latest Guidelines
For bronchial asthma exacerbation, prednisolone should be administered at a dose of 30-40 mg daily until lung function returns to the patient's previous best, typically requiring 5-7 days of treatment without the need for tapering. 1
Dosing Recommendations
- Prednisolone 30-40 mg daily is the recommended dose for adults with asthma exacerbations 1
- For children, the recommended dose is 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 1, 2
- Treatment should continue until lung function values have returned to previous best 1
- Though 7 days' treatment will often be sufficient, treatment may need to be continued for up to 21 days in some cases 1
- Short courses of oral steroids (up to two weeks) do not need to be tapered; oral steroids can be stopped from full dosage 1
Administration Route
- Oral administration is preferred as intravenous administration offers no advantages 1
- For patients who are seriously ill or vomiting, intravenous hydrocortisone 200 mg every six hours can be used 1
Clinical Indications for Corticosteroid Treatment
- Day-by-day worsening of symptoms and peak expiratory flow to below 60% of patient's best 1
- Sleep disturbance till midday 1
- Diminishing response to inhaled bronchodilators 1
- Emergency use of nebulized or injected bronchodilators 1
Monitoring and Follow-up
- Measure and record peak expiratory flow 15-30 minutes after starting treatment and thereafter according to response 1
- Continue high doses of steroids until improvement is noted 1
- Treatment should continue until lung function values have returned to previous best 1
Important Considerations
- Corticosteroid treatment provides important benefits to patients presenting with acute exacerbations of asthma 1
- Short courses of oral steroids produce very low rates of gastrointestinal bleeding, with the greatest risk in patients with a history of gastrointestinal bleeding or those taking anticoagulants 1
- Research has shown that even lower doses of corticosteroids (such as hydrocortisone 50 mg IV four times a day) can be as effective as higher doses in resolving acute severe asthma 3
- A single dose of oral prednisolone (60 mg for patients >5 years) along with bronchodilator therapy can significantly reduce the need for hospital admission in patients with acute bronchial asthma 4
Discharge Planning
- All patients should be discharged taking prednisolone tablets (30 mg daily or more) for one to three weeks 1
- Patients should be offered education about their condition and its management 1
- A 5-day course of prednisolone may be sufficient for some patients, provided they receive inhaled steroids and a personal asthma management plan 5