From the Guidelines
For an asthma exacerbation requiring IV steroids, methylprednisolone is the preferred medication, typically administered at a dose of 125 mg IV, as it has been shown to hasten the resolution of airflow obstruction and may reduce admission to the hospital 1. When managing asthma exacerbations, it is crucial to consider the most effective treatment options to reduce morbidity, mortality, and improve quality of life.
- The use of systemic corticosteroids, such as methylprednisolone, has been proven to be effective for acute asthma exacerbations, as they address the inflammatory component of the disease 1.
- The early administration of corticosteroids is essential, as their anti-inflammatory effects may not be apparent for 6 to 12 hours 1.
- In adults, a typical initial dose of methylprednisolone is 125 mg, with a dose range of 40 mg to 250 mg, and a typical dose of dexamethasone is 10 mg 1.
- It is also important to consider concurrent treatment with inhaled beta-agonists and anticholinergics, as well as oxygen therapy to maintain oxygen saturation above 92%.
- Monitoring for potential side effects of IV steroids, including hyperglycemia, hypertension, mood changes, and electrolyte abnormalities, is also crucial.
- The goal of treatment is to quickly reduce inflammation and improve airflow, and then transition to oral therapy as soon as the patient stabilizes.
From the FDA Drug Label
Following the initial emergency period, consideration should be given to employing a longer acting injectable preparation or an oral preparation When high dose therapy is desired, the recommended dose of methylprednisolone sodium succinate for injection is 30 mg/kg administered intravenously over at least 30 minutes. This dose may be repeated every 4 to 6 hours for 48 hours.
The recommended IV steroid regimen for asthma exacerbation is 30 mg/kg of methylprednisolone administered intravenously over at least 30 minutes, which may be repeated every 4 to 6 hours for 48 hours 2.
From the Research
IV Steroid Regimen for Asthma Exacerbation
- The use of corticosteroids in asthma is a must, but the route of administration in acute exacerbation is debatable 3.
- A study comparing oral vs intravenous steroids in adults admitted with acute exacerbation of bronchial asthma found that both groups had similar efficacy in improving peak expiratory flow rate (PEF) after 72 hours 3.
- Another study assessed the efficacy and safety of different doses and durations of oral steroids for adults and children with asthma exacerbations, and found no convincing evidence of differences in outcomes between higher dose or longer course and lower dose or shorter course of prednisolone or dexamethasone 4.
- The choice of oral corticosteroid regimen for acute asthma exacerbation should be based on individual patient needs and preferences, as well as consideration of potential side effects 4.
- Other studies have investigated the use of adjunctive therapies such as heliox-driven albuterol therapy 5, 6 and ipratropium and/or intravenous magnesium 7 in acute asthma exacerbations, but these are not directly related to IV steroid regimens.