Prednisone Dosage and Duration for Asthma
For acute asthma exacerbations, administer prednisone 30-60 mg daily (or 1-2 mg/kg in children, maximum 60 mg) for 3-10 days, with no tapering required for short courses. 1
Acute Exacerbation Management
Initial Dosing
- Start with prednisone 30-60 mg orally as a single daily dose or divided into two doses for adults presenting with acute severe asthma 1
- For children, use 1-2 mg/kg/day (maximum 60 mg/day) 1
- Administer the first dose immediately upon recognition of severe exacerbation 1
Duration of Treatment
- Continue prednisone for 3-10 days until control is established, then stop abruptly without tapering 1
- The optimal duration appears to be 5-10 days, as 5-day courses may be sufficient when patients are on inhaled corticosteroids, though 10-day courses provide slightly better symptom control 2
- Continue until 2 days after control is established, then discontinue 1
When to Use IV Corticosteroids Instead
- If the patient is vomiting or unable to tolerate oral medications, use intravenous hydrocortisone 200 mg every 6 hours instead of oral prednisone 3
- IV hydrocortisone can be given as 50-200 mg every 6 hours for 48 hours, then transition to oral prednisone 4
Indications for Rescue Courses
Initiate prednisone when any of the following occur: 1
- Symptoms and peak expiratory flow (PEF) progressively worsen day by day
- PEF falls below 60% of patient's personal best
- Sleep is disturbed by asthma symptoms
- Morning symptoms persist until midday
- Diminishing response to inhaled bronchodilators
- Emergency use of nebulized or injected bronchodilators required
Dosing by Severity
Moderate Exacerbations
- Prednisone 30-40 mg daily for patients discharged from emergency settings 1
- Continue regular inhaled corticosteroids and beta-agonists as needed 1
Severe or Life-Threatening Features
- Prednisone 30-60 mg orally OR intravenous hydrocortisone 200 mg, or both 1
- Add ipratropium bromide to bronchodilator therapy 1
- Consider aminophylline 250 mg IV over 20 minutes if not responding 1
Critical Timing Considerations
- Corticosteroids require 6-12 hours to manifest anti-inflammatory effects, making early administration essential 3
- Clinical improvement in symptoms and FEV1 occurs within the first 24 hours, but sputum eosinophils and inflammatory markers don't improve until 48 hours 5
- Relapse prevention is most effective during the period of steroid administration, with relapse rates increasing after discontinuation 6
Common Pitfalls to Avoid
- Do not use short 5-6 day Medrol dose packs for acute exacerbations—they are often insufficient and lead to early relapse 7
- No tapering is needed for short courses (less than 2 weeks) 1
- Do not discharge patients without ensuring 1-3 weeks of prednisone if they had severe exacerbations 3, 7
- Do not add antibiotics unless bacterial infection is clearly documented 3
Post-Discharge Management
After acute treatment: 7
- Provide prednisone 30-60 mg daily for 1-3 weeks total depending on severity
- Increase or continue inhaled corticosteroid dose (e.g., beclomethasone 400 mcg twice daily) 1
- Provide written asthma action plan and peak flow meter 3, 7
- Schedule follow-up within 1 week with primary care and within 4 weeks with respiratory specialist 7
Adverse Effects to Monitor
Short-term use (3-10 days) may cause: 1
- Reversible glucose metabolism abnormalities
- Increased appetite and fluid retention
- Weight gain and facial flushing
- Mood alterations
- Hypertension (monitor in susceptible patients)
- Peptic ulcer symptoms (rare)