From the Guidelines
For an asthma exacerbation, a typical prednisone prescription is 40-60 mg once daily for 5-7 days with no taper needed for this short course. The medication should be taken in the morning with food to minimize gastrointestinal side effects and sleep disturbances. For children, the dosage is usually 1-2 mg/kg/day (maximum 60 mg) for the same duration. Prednisone works by reducing inflammation in the airways, decreasing mucus production, and enhancing the effects of bronchodilators. Common side effects include increased appetite, mood changes, elevated blood sugar, and fluid retention, but these are generally temporary with short courses. While taking prednisone, patients should continue using their rescue inhaler as needed and maintenance medications as prescribed. If symptoms worsen or don't improve after 2-3 days of treatment, medical attention should be sought. Patients with diabetes should monitor blood glucose more frequently while on prednisone.
Key Considerations
- The dose and duration of prednisone may vary depending on the severity of the exacerbation and the patient's response to treatment 1.
- There is no known advantage for higher doses of corticosteroids in severe asthma exacerbations, nor is there any advantage for intravenous administration over oral therapy 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 3-10 days, with no need to taper the dose for courses less than 1 week 1.
- Patients should be monitored closely for signs of improvement or worsening of symptoms, and adjustments to treatment should be made as needed 1.
From the Research
Asthma Exacerbation Treatment
- Asthma exacerbations can be treated with oral corticosteroids, such as prednisone, which have a potent anti-inflammatory effect 2.
- Short courses of systemic corticosteroids, including prednisone, are effective for resolving acute asthma symptoms, but their benefits must be balanced against potential side effects 3.
- The optimal dosing of oral steroids for asthma exacerbations is not well established, and evidence is limited regarding the efficacy and safety of different dosing regimens 2.
Prednisone Prescription
- Prednisone is a commonly prescribed oral corticosteroid for asthma exacerbations, but its use should be balanced against potential side effects, such as loss of bone density, hypertension, and gastrointestinal ulcers/bleeds 3.
- There is no convincing evidence of differences in outcomes between higher and lower doses of prednisone or between longer and shorter courses of treatment 2.
- Patients and primary care physicians should consider a cumulative prednisone dose of 1 g per year as a relevant threshold to minimize potential side effects 3.
Alternative Treatment Options
- Inhaled corticosteroids, such as fluticasone, can be used to reduce the risk of exacerbations and the need for oral corticosteroids in patients with mild asthma 4.
- Other treatment options, such as short-acting beta2 agonists, ipratropium bromide, and magnesium sulfate, can be used in addition to or instead of oral corticosteroids to manage asthma exacerbations 2, 5.
- Asthma action plans can help patients manage symptoms at home and reduce the need for oral corticosteroids 4.