Recommended Corticosteroid Dosing for Acute Asthma Exacerbations
For acute asthma exacerbations, adults should receive prednisone 40-60 mg daily for 5-10 days without tapering, while children should receive 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days. 1
Adult Dosing
- Oral prednisone 40-80 mg/day until peak expiratory flow reaches 70% of predicted or personal best 1
- For outpatient "burst" therapy, use 40-60 mg in single or 2 divided doses for 5-10 days 1
- Methylprednisolone 60-80 mg/day for 3-10 days is an alternative option 2
- Prednisolone 60 mg/day for 3-10 days can also be used 2
Pediatric Dosing
- Prednisone 1-2 mg/kg/day in 2 divided doses (maximum 60 mg/day) until peak expiratory flow reaches 70% of predicted or personal best 2, 1
- For outpatient "burst" therapy, use 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 1
Route of Administration
- Oral administration is preferred when patients can tolerate it 1
- No advantage has been found for intravenous administration over oral therapy provided gastrointestinal absorption is not impaired 2, 1
- If IV administration is necessary, methylprednisolone 125 mg (dose range: 40-250 mg) is typically used 2
Duration of Therapy
- Total course typically lasts 3-10 days 1
- For courses less than 7 days, there is no need to taper the dose 1, 3
- For slightly longer courses (up to 10 days), tapering is likely unnecessary, especially if patients are concurrently taking inhaled corticosteroids 1
- Treatment should continue until lung function values have returned to previous best, which often takes 7 days but may require up to 21 days 2
Important Clinical Considerations
- Systemic corticosteroids should be administered early in the treatment of acute exacerbations, as their anti-inflammatory effects may take 6-12 hours to become apparent 2, 1
- Higher doses of corticosteroids have not shown additional benefit in severe asthma exacerbations 1, 4
- A short course of prednisone has been shown to reduce early relapse rates after emergency room treatment of acute asthma 5
- Inhaled corticosteroids in addition to systemic corticosteroids may reduce the risk of hospital admission in emergency department treatment of moderate-to-severe asthma exacerbations 6
Pitfalls to Avoid
- Delaying administration of systemic corticosteroids during acute exacerbations can lead to poorer outcomes 1
- Unnecessarily high doses of corticosteroids increase the risk of adverse effects without providing additional clinical benefit 1, 4
- Tapering short courses (less than 7 days) of corticosteroids is unnecessary and may lead to underdosing during the critical period 2, 1
- The greatest risk of gastrointestinal bleeding with short-course steroids is in patients with a history of gastrointestinal bleeding or those taking anticoagulants 2