Prednisone 5mg Dose Pack for a 16-Year-Old with Asthma Exacerbation
For a 16-year-old experiencing an asthma exacerbation requiring systemic corticosteroids, prescribe prednisone 40-60 mg daily (8-12 tablets of 5mg) in a single morning dose or divided into two doses for 5-10 days, with no taper necessary for courses under 10 days. 1
Dosing Regimen
The standard outpatient burst regimen is 40-60 mg daily for 5-10 days in adolescents and adults. 1 This translates to:
- 8-12 tablets of 5mg prednisone daily (depending on severity and patient weight)
- Administered as a single morning dose or divided into two doses 1
- No tapering required for courses lasting 5-10 days, especially if the patient is concurrently using inhaled corticosteroids 1
For patients requiring emergency department treatment with more severe exacerbations, the initial dose is 1-2 mg/kg in 2 divided doses (maximum 60 mg/day) until peak expiratory flow reaches 70% of predicted or personal best. 1
Administration Timing and Considerations
Administer prednisone in the morning prior to 9 AM to minimize adrenal suppression, as maximal adrenal cortex activity occurs between 2 AM and 8 AM. 2 Taking the medication before, during, or immediately after meals reduces gastric irritation. 2
Evidence Supporting This Approach
The guidelines consistently demonstrate that:
- Oral corticosteroids are equally effective as intravenous administration for asthma exacerbations, provided gastrointestinal absorption is intact 1
- Lower doses (40-60 mg) are as effective as higher doses for resolving acute severe asthma 3
- Short courses (5-10 days) effectively reduce exacerbations, hospitalizations, and need for beta-agonist therapy 1
Alternative: Single-Dose Dexamethasone
Recent evidence supports an alternative approach: a single dose of oral dexamethasone 0.3-0.6 mg/kg (maximum 18 mg) is non-inferior to 5 days of prednisone for mild-to-moderate exacerbations. 4, 5, 6 This offers:
- Improved compliance by eliminating multi-day dosing 4, 5
- Similar outcomes in symptom resolution, admission rates, and relapse rates 5
- Longer half-life (36-72 hours) compared to prednisone's 12-36 hours 7
However, the traditional 5-day prednisone course remains the guideline-recommended standard. 1
Critical Concurrent Management
Systemic corticosteroids alone are insufficient—the patient must also receive:
- Inhaled short-acting beta-agonists (albuterol/salbutamol) for immediate bronchodilation 1, 8
- Initiation or continuation of inhaled corticosteroids as controller therapy to prevent future exacerbations 8, 9
- Assessment for need to step up long-term controller therapy (e.g., adding long-acting beta-agonists to inhaled corticosteroids) 1
Common Pitfalls to Avoid
Do not use a pre-packaged "dose pack" designed for adults without adjustment—these typically contain 21 tablets with a tapering schedule (starting at 30 mg) that is:
- Insufficient for acute asthma (needs 40-60 mg daily) 1
- Unnecessarily tapered (no taper needed for short courses) 1
Do not prescribe systemic corticosteroids without ensuring the patient has:
- Adequate bronchodilator therapy during the acute phase 1, 9
- A plan for long-term controller medication to prevent recurrence 8
- Follow-up within 48 hours to assess response 9
Monitoring and Follow-Up
Reassess within 48 hours to ensure:
- Peak expiratory flow improves to >70% of predicted or personal best 9
- Symptoms are resolving and short-acting beta-agonist use is decreasing 1
- Long-term controller therapy is optimized 1
If the patient requires systemic corticosteroids more than twice yearly, this indicates inadequate long-term control and necessitates stepping up maintenance therapy with higher-dose inhaled corticosteroids and/or addition of long-acting beta-agonists. 1