Recommended Dosage of Omnacortil (Prednisolone) for Asthmatic Cough
For asthmatic cough, the recommended dose of Omnacortil (prednisolone) is 30-40 mg daily for adults, typically for a short course of 5-10 days until symptoms resolve.
Dosing Guidelines for Different Clinical Scenarios
For Cough Variant Asthma
- For suspected cough variant asthma, prednisolone 30 mg daily for 2 weeks is recommended as a diagnostic-therapeutic trial 1, 2
- After diagnosis is confirmed, patients should be transitioned to inhaled corticosteroids for long-term management 2, 3
- Management should follow national asthma guidelines, with appropriate adjustments for cough variant asthma 1
For Acute Asthma Exacerbation
- For adults with asthma exacerbations, prednisolone 30-40 mg daily is recommended 3, 4
- Treatment should continue until lung function returns to previous best values, typically 3-10 days 3
- Short courses (up to two weeks) do not need to be tapered; oral steroids can be stopped from full dosage 3
For Eosinophilic Bronchitis
- Prednisolone 30 mg/day for 2 weeks is recommended for suspected eosinophilic bronchitis 1, 2
- If no response is seen within 2 weeks, cough is unlikely to be due to eosinophilic airway inflammation 1
Administration Considerations
Duration of Treatment
- For most asthmatic coughs, 5-10 days of treatment is sufficient 3, 5
- Some cases may require up to 21 days of treatment 3
- Response should be assessed within 3 days of starting treatment 2
Dosage Formulation
- Prednisolone sodium phosphate oral solution may be used at 15-60 mg prednisolone base per day depending on severity 4
- For children, the recommended dose is 1-2 mg/kg/day (maximum 60 mg/day) 3, 4
Monitoring and Follow-up
Assessment of Response
- Improvement should be measured by cough frequency, severity, and impact on quality of life 2
- Peak expiratory flow (PEF) should be measured 15-30 minutes after starting treatment and thereafter according to response 3
- If no improvement is seen within 2 weeks, reconsider diagnosis and treatment approach 2
Transition to Maintenance Therapy
- After favorable response, determine proper maintenance dosage by decreasing initial dose in small decrements at appropriate intervals 4
- For long-term management, transition to inhaled corticosteroids 2, 3
Important Considerations and Caveats
Potential Side Effects
- Short courses of oral steroids produce very low rates of gastrointestinal bleeding 3
- Long-term systemic corticosteroid use carries significant side effects that must be weighed against potential benefits 2
Alternative Diagnoses
- In patients with apparently corticosteroid-resistant cough variant asthma, alternative diagnoses should be considered 1
- Always rule out other common causes of chronic cough before considering prednisolone 2
Special Populations
- For severe post-infectious cough, consider prednisolone 30-40 mg daily after failure of inhaled ipratropium bromide and inhaled corticosteroids 1, 2
- For interstitial lung disease-associated cough, approach depends on specific type of ILD 2
Evidence Quality
- The recommendation for prednisolone 30 mg/day for 2 weeks in cough variant asthma is based on expert opinion rather than high-quality clinical trials 1
- Studies comparing different doses of corticosteroids in acute asthma suggest that lower doses (equivalent to prednisolone 20 mg four times daily) are as effective as higher doses 6