Prednisone Dosing for Sick Patients with Asthma History (No Active Exacerbation)
If the patient has a history of asthma but is NOT currently experiencing an asthma exacerbation, systemic corticosteroids like prednisone are NOT indicated for their intercurrent illness. 1, 2
Key Clinical Decision Point
The critical distinction here is whether the patient is experiencing an asthma exacerbation versus simply being "sick" with another illness (e.g., upper respiratory infection, pneumonia, other systemic illness) while having asthma as a comorbidity. 2
When Prednisone IS Indicated (Active Asthma Exacerbation):
If the patient develops signs of an actual asthma exacerbation during their illness, then systemic corticosteroids are appropriate:
- Prednisone 30-60 mg daily is the recommended dose for acute asthma exacerbations 1
- Prednisone 30-40 mg daily for mild exacerbations until symptoms resolve and lung function returns to baseline, typically 7 days 2
- Oral administration is equally effective as intravenous steroids and is the preferred route 2
- No tapering is required for courses under 2 weeks 2, 3
When Prednisone IS NOT Indicated:
For a patient who is sick with another condition but whose asthma is stable (no exacerbation), do not prescribe systemic corticosteroids. 1
- Continue their baseline inhaled corticosteroids at their usual maintenance dose 1
- Monitor closely for development of asthma symptoms, as intercurrent illness can trigger exacerbations 2
- Ensure adequate bronchodilator availability for rescue use 1
Clinical Assessment for Exacerbation
Assess for these signs that would indicate an actual asthma exacerbation requiring prednisone: 2
- Increased shortness of breath or work of breathing
- Inability to speak in full sentences
- Increased rescue inhaler use beyond baseline
- Decreased peak expiratory flow (if measurable)
- Oxygen saturation <90% 2
- Wheezing or chest tightness beyond baseline
Important Caveats
The evidence provided focuses on acute asthma exacerbations, not prophylactic steroid use in stable asthma patients with intercurrent illness. 1, 2 There is no indication to give systemic corticosteroids to prevent an exacerbation in a patient whose asthma is currently stable, even if they have another illness. 1, 2
If the patient is elderly or has multiple comorbidities, monitor more closely for corticosteroid side effects if steroids become necessary, including hyperglycemia, hypertension, and gastrointestinal bleeding risk. 2