What is the recommended dose of prednisone (corticosteroid) for treating wheezing?

Prednisone Dosing for Wheezing

For acute wheezing from asthma exacerbations, use prednisone 40-60 mg daily for adults or 1-2 mg/kg/day (maximum 60 mg/day) for children, given for 5 days without tapering. 1

Adult Dosing Algorithm

• Start with prednisone 40-60 mg orally once daily (or in 2 divided doses) for 5 days 1, 2
• Continue treatment until peak expiratory flow reaches 70% of predicted or personal best 1
• For severe exacerbations requiring hospitalization, use 40-80 mg/day in divided doses until PEF reaches 70% of predicted 1
• The British Thoracic Society supports an alternative range of 30-60 mg daily, though the higher end (40-60 mg) represents current standard practice 1, 2

Pediatric Dosing Algorithm

• Give prednisone 1-2 mg/kg/day in 2 divided doses (maximum 60 mg/day) for 3-10 days 1, 3
• The maximum daily dose is 60 mg regardless of weight 1
• Continue until peak expiratory flow reaches 70% of predicted or personal best 1
• Dexamethasone 0.3-0.6 mg/kg daily for 1-5 days is an effective alternative with similar efficacy 3

Route of Administration

• Oral administration is strongly preferred and equally effective as intravenous therapy 1, 2
• There is no advantage to IV administration unless the patient is vomiting or has impaired gastrointestinal absorption 1
• If IV administration is necessary, use hydrocortisone 100 mg every 6 hours or methylprednisolone 125 mg 1

Duration and Tapering

• For courses of 5-10 days, do not taper the dose—stop abruptly 1, 2
• Tapering short courses is unnecessary and may lead to underdosing during the critical recovery period 1
• The typical outpatient course lasts 5-10 days 1, 2
• For severe cases, treatment may extend up to 21 days until lung function returns to baseline 1

COPD Exacerbations (If Applicable)

• Use prednisone 40 mg daily for 5 days for COPD exacerbations 4, 2
• A 5-day course is as effective as 10-14 day courses while minimizing adverse effects 2
• Blood eosinophil count ≥2% predicts better response, though treatment should not be withheld based on eosinophil levels alone 2

Critical Clinical Considerations

• Administer systemic corticosteroids early in moderate-to-severe exacerbations, as their anti-inflammatory effects take 6-12 hours to become apparent 1
• Higher doses (beyond 60-80 mg/day) have not shown additional benefit in severe exacerbations 1
• Research demonstrates that even low-dose regimens (hydrocortisone 50 mg IV four times daily) are as effective as high-dose regimens (500 mg) for acute severe asthma 5

Important Pitfalls to Avoid

• Do not delay corticosteroid administration—early treatment improves outcomes 1
• Do not use unnecessarily high doses—doses above 60-80 mg/day increase adverse effects without additional benefit 1
• Do not taper courses lasting less than 7-10 days, especially if the patient is on inhaled corticosteroids 1, 2
• Do not extend treatment beyond 5-7 days for routine exacerbations—longer courses increase side effects without improving outcomes 2
• The greatest risk of gastrointestinal bleeding occurs in patients with a history of GI bleeding or those taking anticoagulants 1

Concurrent Therapy

• Continue nebulized or inhaled beta-agonists every 4 hours as needed 1
• After completing oral prednisone, optimize inhaled corticosteroid/long-acting beta-agonist combination therapy to prevent future exacerbations 2
• Ensure patients continue inhaled corticosteroids at appropriate maintenance doses 1