What short-term steroid can be given to an 8-year-old with mild persistent asthma (MPA) experiencing an exacerbation?

Short-Term Steroid Treatment for 8-Year-Old with Mild Persistent Asthma Exacerbation

For an 8-year-old child experiencing an asthma exacerbation, give oral prednisolone or prednisone at 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days. 1

Specific Dosing Recommendations

First-Line Options

Prednisolone or Prednisone (Preferred)

• Dose: 1-2 mg/kg/day in single or 2 divided doses 1
• Maximum daily dose: 60 mg/day 1, 2
• Duration: 3-10 days 1, 2
• No tapering needed: For courses less than 10 days, especially if the child is on inhaled corticosteroids 1

Alternative Option

Dexamethasone

• Dose: 0.3-0.6 mg/kg as a single dose 3, 4
• Advantage: Single-dose administration improves compliance and is equally effective 3
• Duration: Can be given as 1-5 days depending on severity 4

Key Clinical Considerations

Route of Administration

• Oral route is preferred over intravenous administration when gastrointestinal absorption is intact 1
• No advantage to IV steroids unless the child cannot tolerate oral intake 1

Treatment Duration Algorithm

• Continue until: Peak expiratory flow reaches 70% of predicted or personal best 1
• Typical course: 3-10 days is sufficient for most exacerbations 1, 2
• No taper required: When treatment duration is ≤10 days and patient is on inhaled corticosteroids 1

Concurrent Therapy

• Inhaled corticosteroids can be started at any point during the exacerbation treatment 1
• Short-acting beta-agonists should be used concurrently for bronchodilation 1, 5

Important Pitfalls to Avoid

Common Dosing Errors

• Don't underdose: The updated guidelines increased the maximum from 30 mg to 60 mg daily for children 1
• Don't use sustained-release theophylline as an alternative in young children due to risk of adverse effects with febrile illnesses 1

Monitoring Requirements

• Assess response within 4-6 weeks of initiating any anti-inflammatory therapy 1
• Stop treatment if no clear benefit is observed within this timeframe 1

Evidence Quality Note

The recommendation for oral corticosteroids in pediatric asthma exacerbations is based on high-quality guideline evidence from the National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3 1. Both prednisone/prednisolone and dexamethasone have been shown to reduce hospital admissions and unscheduled return visits with minimal side effects 4. The single-dose dexamethasone option represents newer evidence showing equivalent efficacy with improved compliance 3.