What is the typical dose of prednisone (corticosteroid) for treating asthma?

Prednisone Dosing for Asthma

For adults with asthma exacerbations, use prednisone 40-60 mg daily for 5-10 days without tapering; for children, use 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days. 1

Adult Dosing Algorithm

Outpatient "burst" therapy:

• Prednisone 40-60 mg daily (single morning dose or divided into 2 doses) for 5-10 days 1, 2
• Continue until peak expiratory flow (PEF) reaches 70% of predicted or personal best 1
• No tapering required for courses ≤10 days, especially if patient is on inhaled corticosteroids 1, 2

Severe exacerbations requiring hospitalization:

• Prednisone 40-80 mg/day in divided doses until PEF reaches 70% of predicted 1
• Alternative: Prednisolone 30-60 mg daily 2
• Treatment duration typically 5-10 days, but may extend to 21 days if lung function has not returned to baseline 1, 2

Pediatric Dosing Algorithm

• Prednisone 1-2 mg/kg/day in 2 divided doses (maximum 60 mg/day regardless of weight) 1
• Continue for 3-10 days until PEF is 70% of predicted or personal best 1
• No tapering necessary for short courses 1

Route of Administration

Oral administration is strongly preferred and equally effective as intravenous therapy when gastrointestinal absorption is intact 1, 2. There is no advantage to IV administration unless the patient is vomiting or severely ill 1, 2.

If IV route necessary:

• Hydrocortisone 200 mg every 6 hours 2
• Methylprednisolone 125 mg (dose range 40-250 mg) 1

Timing Considerations

• Administer in the morning prior to 9 AM to align with natural cortisol rhythm and minimize adrenal suppression 3
• Start systemic corticosteroids early in acute exacerbations, as anti-inflammatory effects take 6-12 hours to become apparent 1
• For multiple daily doses, distribute evenly throughout the day 3

Duration and Tapering

Key principle: Short courses do not require tapering 1, 2

• Courses <7-10 days: No taper needed, especially if patient continues inhaled corticosteroids 1, 2
• Typical outpatient course: 5-10 days 1, 4
• Continue treatment until 2 days after control is established, not for an arbitrary fixed period 1
• Some cases may require up to 21 days until lung function returns to baseline 1, 2

Evidence Quality and Dose Comparison

Higher doses (120-180 mg/day) show no additional benefit compared to standard doses (40-60 mg/day) 1. A well-designed study demonstrated that hydrocortisone 50 mg IV four times daily was as effective as 200 mg or 500 mg doses in resolving acute severe asthma 5. This supports using the lower end of the recommended dose range to minimize adverse effects without compromising efficacy.

A landmark trial showed that prednisone 40 mg daily (tapered over 8 days) significantly reduced early relapse rates after emergency department treatment compared to placebo, with relapse occurring in only 6% versus 24% of patients during the steroid administration period 6.

Critical Pitfalls to Avoid

• Do not delay steroid administration during acute exacerbations—this leads to poorer outcomes 1
• Do not use unnecessarily high doses (>80 mg/day)—they increase adverse effects without additional benefit 1, 5
• Do not taper short courses (<7-10 days)—this is unnecessary and may lead to underdosing during the critical recovery period 1, 2
• Do not use arbitrarily short courses (e.g., 3 days) without assessing clinical response—minimum evidence-based duration is 5 days 1, 4
• Do not rely on clinical impression alone—always measure PEF objectively 15-30 minutes after starting treatment 1

Monitoring Response

• Measure PEF 15-30 minutes after initiating treatment 1, 2
• Continue monitoring according to clinical response 1
• Assess symptoms and PEF daily until improvement is sustained 1
• If no improvement after 15-30 minutes of initial bronchodilator and corticosteroid treatment, escalate care 1

Alternative Corticosteroid Options

All oral corticosteroids are equally effective at equivalent doses 1:

• Prednisolone: Same dosing as prednisone 1
• Methylprednisolone: 60-80 mg/day for adults; 0.25-2 mg/kg/day for children 1

Concurrent Therapy

• Continue or initiate inhaled corticosteroids at appropriate doses 1, 4
• Administer with food or milk to reduce gastric irritation 3
• Consider antacids between meals for large doses to prevent peptic ulcers 3