What is a suitable prednisone (corticosteroid) taper regimen for asthma?

From the Guidelines

For asthma exacerbations, a typical prednisone taper starts with 40-60 mg daily for 5-7 days, and for courses of less than 1 week, there is no need to taper the dose, as stated in the 2009 guidelines by the National Asthma Education and Prevention Program expert panel report 3 1.

Key Considerations

• The dose and duration of prednisone should be individualized based on the severity of the asthma exacerbation and the patient's response to treatment.
• Patients should continue using their maintenance inhalers as prescribed while taking prednisone.
• Common side effects of prednisone may include increased appetite, mood changes, insomnia, and elevated blood sugar, particularly with longer courses.
• If symptoms worsen during the taper, patients should contact their healthcare provider rather than adjusting the dose themselves.

Evidence-Based Recommendations

• According to the 2009 guidelines by the National Asthma Education and Prevention Program expert panel report 3 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.
• The total course of systemic corticosteroids for an asthma exacerbation requiring an ED visit or hospitalization may last from 3 to 10 days, and for slightly longer courses (e.g., up to 10 days), there probably is no need to taper, especially if patients are concurrently taking ICSs 1.

Clinical Implications

• The British Thoracic Society guidelines suggest that the indications for rescue courses of steroids should include day-by-day worsening of symptoms and peak expiratory flow to below 60% of patient's best; sleep disturbance till midday; diminishing response to inhaled bronchodilators; emergency use of nebulised or injected bronchodilators 1.
• A gradual reduction of prednisone over 1-2 weeks may be necessary for some patients, but the exact dosing and duration should be determined by the healthcare provider based on the individual patient's response to treatment.

From the FDA Drug Label

If after long-term therapy the drug is to be stopped, it is recommended that it be withdrawn gradually rather than abruptly

• The FDA drug label recommends gradual withdrawal of prednisone after long-term therapy, rather than abrupt cessation.
• A specific tapering schedule for asthma is not provided in the label.
• However, the label does mention that the dosage requirements are variable and must be individualized based on the disease under treatment and the patient's response.
• For multiple sclerosis, a specific tapering schedule is provided, but it is not directly applicable to asthma.
• In general, the goal of tapering is to minimize withdrawal symptoms and pituitary-adrenal suppression while maintaining adequate control of the underlying disease.
• The label suggests that constant monitoring is needed to adjust the dosage and prevent relapse.
• It is essential to consult with a healthcare provider to determine a safe and effective tapering schedule for prednisone in patients with asthma 2.

From the Research

Asthma Treatment and Prednisone Taper

• The provided studies do not directly address the optimal prednisone taper for asthma, but they discuss various treatment approaches for managing asthma, including the use of inhaled corticosteroids and long-acting beta-agonists 3, 4, 5.
• Inhaled corticosteroids are considered the most potent and effective anti-inflammatory agents for treating asthma, and adding a long-acting beta 2-adrenergic bronchodilator can improve pulmonary function and symptoms 5.
• The use of oral corticosteroids, such as prednisone, is standard practice in the outpatient management of acute severe exacerbations of asthma, but the optimal dosing regimen and total burst dose are not well established 6.
• A study on oral corticosteroid burst therapy found that physicians tend to prescribe less than the upper dose recommended in guidelines, with many prescribing a total steroid burst dose below the lower end of the recommended dose range 6.
• There is no specific guidance on prednisone tapering for asthma in the provided studies, but it is essential to follow established guidelines and consult with a healthcare professional to determine the best treatment approach for individual patients.

Key Considerations

• Asthma treatment should be tailored to the individual patient's needs and severity of symptoms 3, 4, 5.
• Inhaled corticosteroids and long-acting beta-agonists can be effective in managing asthma, but the optimal treatment approach may vary depending on the patient's response to therapy 3, 4, 5.
• Oral corticosteroids, such as prednisone, should be used judiciously and with careful consideration of the potential side effects and benefits 6.

Treatment Approaches

• Inhaled corticosteroids and long-acting beta-agonists can be used as maintenance therapy to control asthma symptoms and prevent exacerbations 3, 4, 5.
• Anti-inflammatory reliever therapy with budesonide-formoterol can be effective in ensuring asthma control and preventing exacerbations in patients with mild asthma 7.
• Oral corticosteroid burst therapy can be used to manage acute severe exacerbations of asthma, but the optimal dosing regimen and total burst dose require further study 6.