Oral Corticosteroid Dosing for Asthma Exacerbation in a 13-Year-Old
Give prednisolone 1-2 mg/kg/day in 2 divided doses (maximum 60 mg/day) for 3-10 days without tapering. 1, 2, 3
Specific Dosing Algorithm
Standard Pediatric Regimen
- Dose: 1-2 mg/kg/day divided into 2 doses 1, 2
- Maximum daily dose: 60 mg regardless of weight 1, 2, 3
- Duration: 3-10 days (typically 5 days is sufficient) 1, 2
- No tapering required for courses lasting less than 7-10 days, especially if the patient is on inhaled corticosteroids 1, 2
Practical Example for a 13-Year-Old
- For a 50 kg adolescent: 50-100 mg/day (use 60 mg maximum), given as 30 mg twice daily 1, 2
- For a 30 kg adolescent: 30-60 mg/day, given as 15-30 mg twice daily 1, 2
Route of Administration
Oral administration is strongly preferred and equally effective as intravenous therapy when the patient can swallow and is not vomiting. 1, 2, 4, 5 Research demonstrates that oral prednisolone has effects equivalent to IV methylprednisolone but is less invasive. 2
Switch to IV hydrocortisone (4 mg/kg initially, then every 6 hours) only if: 2, 6
- Patient is vomiting persistently
- Patient is severely ill and unable to tolerate oral intake
- Gastrointestinal absorption is impaired
Duration and Monitoring
- Continue treatment until peak expiratory flow reaches 70% of predicted or personal best 1, 2
- Most patients require 5-10 days total 1, 2
- Reassess at 4 hours after initial treatment to determine response 1, 2
- No tapering is necessary for courses under 7-10 days 1, 2
Concurrent Essential Therapy
Must be given alongside corticosteroids: 1, 2
- Albuterol 2.5-5 mg nebulized every 20 minutes for 3 doses, then every 1-4 hours as needed 1
- Consider adding ipratropium bromide 0.25-0.5 mg every 20 minutes for 3 doses in moderate-to-severe exacerbations 1
- Oxygen to maintain SpO₂ >92% 6
Critical Timing Considerations
Administer systemic corticosteroids early (within 1 hour of presentation) for all moderate-to-severe exacerbations or when the patient fails to respond promptly to initial bronchodilator therapy. 2 The anti-inflammatory effects take 6-12 hours to become apparent, making early administration crucial. 2, 6
Common Pitfalls to Avoid
- Do not use unnecessarily high doses beyond 2 mg/kg/day (max 60 mg/day), as higher doses have not shown additional benefit in severe exacerbations 1, 2
- Do not taper short courses (less than 7-10 days), as this is unnecessary and may lead to underdosing during the critical recovery period 1, 2
- Do not delay corticosteroid administration while waiting for other assessments, as delayed treatment leads to poorer outcomes 2, 6
- Do not rely solely on inhaled corticosteroids for acute exacerbations; they are insufficient for moderate-to-severe episodes 1, 7
Alternative Corticosteroid Options
If prednisolone is unavailable, equivalent alternatives include: 1, 2
- Prednisone 1-2 mg/kg/day (maximum 60 mg/day) 1, 2
- Methylprednisolone 0.25-2 mg/kg/day in 2 divided doses (maximum 60 mg/day) 2
All oral corticosteroids are equally effective when given at equivalent doses. 2
Evidence Quality Note
These recommendations are based on the National Asthma Education and Prevention Program Expert Panel Report 3 guidelines, which represent the standard of care for pediatric asthma exacerbations. 1, 2 The FDA label for prednisolone specifically endorses the 1-2 mg/kg/day dosing for children with asthma exacerbations uncontrolled by inhaled corticosteroids and long-acting bronchodilators. 3