From the Guidelines
For acute asthma exacerbations, prednisone should be given at a dose of 40-60 mg daily for 5-7 days in adults, and 1-2 mg/kg/day (maximum 60 mg) for 3-5 days in children, as this dosing regimen has been shown to effectively reduce airway inflammation and improve symptoms without requiring tapering in most patients 1, 2.
Key Considerations
- The dose of prednisone for acute asthma exacerbations should not exceed 60 mg daily in adults, as higher doses have not been shown to provide additional benefits 1.
- In children, the recommended dose is 1-2 mg/kg/day (maximum 60 mg) for 3-5 days, which can be adjusted based on the child's response to therapy 2.
- Oral corticosteroids, such as prednisone, work by reducing airway inflammation, decreasing mucus production, and enhancing the effects of beta-agonists on the airways, making them a crucial component of acute asthma exacerbation management 1.
- Alternative corticosteroids, including methylprednisolone and dexamethasone, can be used in place of prednisone, but the dosing regimen may vary 3.
Important Notes
- Patients should continue their regular controller medications during and after the exacerbation, and follow up with their healthcare provider within 1-2 weeks to review their asthma management plan 1.
- The use of intravenous corticosteroids is not recommended, as oral therapy is equally effective and has a lower risk of adverse effects, provided gastrointestinal transit time or absorption is not impaired 1.
- The total course of systemic corticosteroids for an asthma exacerbation requiring an ED visit or hospitalization may last from 3 to 10 days, and tapering is not necessary for courses of less than 1 week 1.
From the Research
Acute Asthma Exacerbation Prednisone Dosing
- The optimal dosing of oral steroids, such as prednisone, for acute asthma exacerbations is not well established, with current guidelines varying between countries and among different guideline producers within the same country 4.
- A 2016 Cochrane review found no convincing evidence of differences in outcomes between higher and lower doses of prednisone or between longer and shorter courses of prednisone or dexamethasone 4.
- The review included 18 studies with a total of 2438 participants and found that the varied interventions and outcomes reported limited the number of meaningful meta-analyses that could be performed 4.
- A 2024 study published in the American Family Physician recommended the use of oral corticosteroids, such as prednisone, in the management of acute asthma exacerbations, but did not provide specific dosing recommendations 5.
- Another study published in 2020 found that high doses of inhaled corticosteroids, in addition to systemic corticosteroids, reduced the risk of hospital admission in patients with moderate-to-severe asthma exacerbations 6.
- The safety of long-acting beta agonists and inhaled corticosteroids in children and adolescents with asthma has been a concern, with some studies suggesting an increased risk of severe asthma exacerbations and growth suppression 7.
- A 2020 study found that combination therapy with inhaled corticosteroids and long-acting beta agonists was associated with a significant reduction in asthma exacerbations over a 15-year period 8.