Recommended Oral Prednisone Dosing for Acute Asthma Exacerbations
For adults with acute asthma exacerbations, the recommended oral prednisone dose is 40-80 mg/day until peak expiratory flow reaches 70% of predicted or personal best. 1
Adult Dosing
- For outpatient "burst" therapy, use 40-60 mg in single or 2 divided doses for a total of 5-10 days 2, 1
- The total course of systemic corticosteroids for an asthma exacerbation requiring emergency department visit or hospitalization typically lasts from 3-10 days 2, 1
- For corticosteroid courses less than 1 week, there is no need to taper the dose 2, 1
- For slightly longer courses (up to 10 days), tapering is probably unnecessary, especially if patients are concurrently taking inhaled corticosteroids 2, 1
Pediatric Dosing
- For children, the recommended dose is 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 in children, use 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 2, 1
Route of Administration
- There is no advantage to intravenous administration over oral therapy, provided gastrointestinal absorption is not impaired 2, 1
- Oral administration is preferred when patients can tolerate it 1
- If IV administration is necessary due to inability to take oral medications, methylprednisolone can be used 1
Important Clinical Considerations
- Higher doses of corticosteroids have not shown additional benefit in severe asthma exacerbations 2, 1, 3
- 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 1
- Low-dose regimens (50 mg hydrocortisone IV every 6 hours) have been shown to be as effective as higher doses (500 mg hydrocortisone IV every 6 hours) in resolving acute severe asthma 3
Alternative Corticosteroid Options
- Dexamethasone can be used as an alternative to prednisone 1
- Some studies suggest 2 days of oral dexamethasone (16 mg daily) is at least as effective as 5 days of oral prednisone in returning patients to normal activity and preventing relapse 4
- Methylprednisolone or prednisolone can also be used at equivalent doses 2, 1
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, 3
- Tapering short courses (less than 7 days) of corticosteroids is unnecessary and may lead to underdosing during the critical period 2, 1
- The British Thoracic Society recommends prednisolone 30-60 mg for acute severe asthma, which is consistent with other guidelines but at the lower end of the dosing range 2