Recommended Dosage and Duration of Oral Prednisone for Asthma Steroid Burst
For adults with asthma exacerbations requiring a steroid burst, the recommended dosage is 40-60 mg of oral prednisone in a single or 2 divided doses for a total of 5-10 days. 1, 2
Adult Dosing
- Prednisone 40-80 mg/day in divided doses until peak expiratory flow (PEF) reaches 70% of predicted or personal best 1
- For outpatient "burst" therapy, use 40-60 mg in single or 2 divided doses for a total of 5-10 days 1, 2
- No advantage has been demonstrated for higher doses of corticosteroids in severe asthma exacerbations 1, 2
- Alternative corticosteroid options include methylprednisolone 60-80 mg/day or prednisolone 60 mg/day for 3-10 days 2
Pediatric Dosing
- Prednisone 1-2 mg/kg/day in 2 divided doses (maximum 60 mg/day) until PEF reaches 70% of predicted or personal best 1
- For outpatient "burst" therapy in children, use 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 1, 2
- The 2007 EPR-3 guidelines updated the maximum dose for children 0-4 years from 30 mg/day to 60 mg/day 1
Duration of Therapy
- The total course of systemic corticosteroids for an asthma exacerbation typically lasts from 3 to 10 days 1, 2
- Research suggests that a 1-week course of oral prednisolone is as effective as a 2-week course for treating asthma exacerbations 3
- For corticosteroid courses of less than 1 week, there is no need to taper the dose 1, 2
- For slightly longer courses (up to 10 days), there probably is no need to taper, especially if patients are concurrently taking inhaled corticosteroids 1, 2
Route of Administration
- No advantage has been found for intravenous administration over oral therapy, provided gastrointestinal absorption is not impaired 1, 2
- Oral administration is preferred when patients can tolerate it 2
- To reduce gastric irritation, prednisone may be taken before, during, or immediately after meals or with food or milk 4
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
- Research has shown a dose-response relationship, with higher doses (0.6 mg/kg/day) providing better improvement in peak flow compared to lower doses (0.2 mg/kg/day) 5
- Despite guidelines, actual practice patterns vary widely, with many physicians prescribing lower than recommended doses 6
Pitfalls to Avoid
- Delaying administration of systemic corticosteroids during acute exacerbations can lead to poorer outcomes 2
- Unnecessarily high doses of corticosteroids increase the risk of adverse effects without providing additional clinical benefit 2, 7
- Tapering short courses (less than 7 days) of corticosteroids is unnecessary and may lead to underdosing during the critical period 1, 2
- For longer-term therapy, abrupt withdrawal should be avoided 4