What is the recommended dosage of prednisone (corticosteroid) for an asthma flare?

Prednisone Dosing for Asthma Exacerbation

For adults with an asthma flare, use prednisone 40-60 mg daily (or 40-80 mg daily for more severe exacerbations) for 5-10 days without tapering. 1

Adult Dosing Algorithm

Standard outpatient "burst" therapy:

• Prednisone 40-60 mg daily in a single dose or divided into 2 doses 1
• Continue until peak expiratory flow reaches 70% of predicted or personal best 1
• Total duration: 5-10 days 1

For more severe exacerbations (ED or hospitalization):

• Prednisone 40-80 mg/day in 1-2 divided doses 1, 2
• Alternative: Prednisolone 30-60 mg daily 1
• Continue until peak expiratory flow reaches 70% of predicted or personal best 1

Pediatric Dosing

For children with asthma exacerbations:

• Prednisone 1-2 mg/kg/day in 2 divided doses 1, 2
• Maximum dose: 60 mg/day 1, 2
• Duration: 3-10 days 1
• Continue until peak expiratory flow reaches 70% of predicted or personal best 1

Duration and Tapering Considerations

No tapering is necessary for short courses:

• For courses less than 7-10 days, tapering is unnecessary and may lead to underdosing during the critical period 1
• This is especially true if patients are concurrently taking inhaled corticosteroids 1
• Research supports that 5 days may be sufficient when patients receive inhaled steroids and have a management plan 3

Treatment should continue until control is established:

• Continue until two days after control is established, not for an arbitrary 3-day period 1
• Most cases resolve in 5-10 days, but some may require up to 21 days until lung function returns to baseline 1

Route of Administration

Oral administration is strongly preferred:

• Oral prednisone has effects equivalent to intravenous methylprednisolone but is less invasive 1, 2
• There is no advantage to IV administration over oral therapy if gastrointestinal absorption is intact 1

IV alternatives (only if vomiting or severe illness prevents oral intake):

• Hydrocortisone 200 mg every 6 hours 1
• Methylprednisolone 125 mg (dose range 40-250 mg) 1

Evidence Quality and Nuances

The guideline recommendations are based on consensus from multiple major societies including the American College of Allergy, Asthma, and Immunology, American Academy of Pediatrics, and British Thoracic Society 1. Research evidence supports that higher doses provide no additional benefit—a 1992 study in Thorax demonstrated that hydrocortisone 50 mg IV four times daily was as effective as 500 mg doses 4.

The 40 mg daily dose has been validated in multiple trials. A 1991 New England Journal of Medicine study showed that 40 mg prednisone tapered over 8 days significantly reduced relapse rates compared to placebo (3/48 vs 11/45, P<0.05) 5. A 1998 study in Annals of Emergency Medicine confirmed that 40 mg daily for 5 days produced acceptable relapse rates of 14.5% 6.

Critical Timing Considerations

Administer systemic corticosteroids early:

• Give early in the ED or outpatient setting for all moderate-to-severe exacerbations 1
• Anti-inflammatory effects take 6-12 hours to become apparent, making early administration critical 1, 2
• Delaying administration leads to poorer outcomes 1

Common Pitfalls to Avoid

Do not use arbitrarily short courses:

• Using 3-day courses without assessing clinical response may result in treatment failure 1
• The evidence-based minimum is 5-10 days 1

Do not use unnecessarily high doses:

• Doses higher than 60-80 mg/day increase adverse effects without additional clinical benefit 1
• Older guidelines suggested 120-180 mg/day, but recent evidence shows no advantage 1

Do not taper short courses:

• Tapering courses less than 7-10 days is unnecessary and may lead to underdosing 1

Monitor response objectively:

• Measure peak expiratory flow 15-30 minutes after starting treatment 1
• Always measure objectively rather than relying on clinical impression alone 1