From the Research
Prednisone for asthma exacerbations should be dosed once daily rather than twice daily (BID). The standard approach is to prescribe 40-60 mg of oral prednisone once daily for 5-7 days for adults experiencing moderate to severe asthma exacerbations. For children, the typical dose is 1-2 mg/kg/day (up to 60 mg) for the same duration. Once-daily dosing is preferred because prednisone has a biological half-life of 18-36 hours, which allows for sustained anti-inflammatory effects throughout a 24-hour period with a single dose. This longer duration of action makes twice-daily dosing unnecessary and may reduce side effects. Morning administration (before 9 AM) is generally recommended to mimic the body's natural cortisol rhythm and minimize disruption to the hypothalamic-pituitary-adrenal axis. For severe exacerbations requiring hospitalization, the regimen might be adjusted, but even then, once-daily dosing is standard practice. No tapering is typically needed for short courses (less than 10 days) of prednisone used for asthma exacerbations.
Key Considerations
- The most recent and highest quality study, 1, found no convincing evidence of differences in outcomes between a higher dose or longer course and a lower dose or shorter course of prednisolone or dexamethasone, or between prednisolone and dexamethasone.
- Another study, 2, found that high doses of inhaled corticosteroids (ICS) in addition to systemic corticosteroids (SCS) reduced the risk of hospital admission in emergency department treatment of moderate-to-severe asthma exacerbations.
- The biological half-life of prednisone, as mentioned in the example answer, supports once-daily dosing.
Dosing Recommendations
- Adults: 40-60 mg of oral prednisone once daily for 5-7 days
- Children: 1-2 mg/kg/day (up to 60 mg) for the same duration
Administration Timing
- Morning administration (before 9 AM) is generally recommended to mimic the body's natural cortisol rhythm and minimize disruption to the hypothalamic-pituitary-adrenal axis.