What is the purpose of steroid (corticosteroid) burst therapy?

From the Guidelines

Steroid burst therapy should be used at a dose of 40-60mg daily for 5-7 days in adults with asthma exacerbations, and 1-2mg/kg/day (maximum 60mg) for the same duration in children, as recommended by the most recent guidelines 1.

Key Considerations

• The dose and duration of steroid burst therapy may vary depending on the individual patient's condition and response to treatment.
• Alternative steroids, such as methylprednisolone (Medrol) or dexamethasone, may be used in certain situations, but the choice of steroid should be based on the specific clinical context and patient factors.
• When administering steroid bursts, it is essential to monitor for potential side effects, such as mood changes, insomnia, and increased blood glucose, especially in patients with diabetes.
• Steroid bursts work by rapidly suppressing inflammatory pathways and inhibiting immune cell function, providing quick symptom relief while allowing time for longer-acting treatments to take effect or for the condition to resolve naturally.

Potential Adverse Effects

• Reversible abnormalities in glucose metabolism, increased appetite, fluid retention, weight gain, facial flushing, mood alteration, hypertension, peptic ulcer, and rarely aseptic necrosis may occur with short-term use of systemic corticosteroids 1.
• Long-term use of systemic corticosteroids may lead to adrenal axis suppression, growth suppression, dermal thinning, hypertension, diabetes, Cushing syndrome, cataracts, muscle weakness, and impaired immune function 1.

Clinical Context

• Steroid burst therapy is commonly used in the management of asthma exacerbations, severe allergic reactions, or autoimmune flares.
• The decision to use steroid burst therapy should be based on a thorough assessment of the patient's condition, including the severity of symptoms, medical history, and potential contraindications.
• Patients should be closely monitored during and after steroid burst therapy to minimize the risk of adverse effects and ensure optimal outcomes.

From the FDA Drug Label

The initial dosage of PredniSONE tablets may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated. In situations of less severity lower doses will generally suffice, while in selected patients higher initial doses may be required The following should be kept in mind when considering alternate day therapy: Basic principles and indications for corticosteroid therapy should apply. Alternate day therapy is a therapeutic technique primarily designed for patients in whom long-term pharmacologic corticoid therapy is anticipated

The steroid burst therapy typically involves high doses of corticosteroids for a short period, but the exact dosage and duration may vary depending on the disease entity being treated.

• The dosage can range from 5 mg to 60 mg per day for prednisone.
• Alternate day therapy is a technique used for long-term pharmacologic corticoid therapy, where twice the usual daily dose is administered every other morning.
• The decision to use steroid burst therapy should be based on the specific disease entity and the patient's response to the treatment 2.
• Methylprednisolone can also be used for steroid burst therapy, with dosages ranging from 4 mg to 48 mg per day 3.

From the Research

Definition and Administration of Steroid Burst Therapy

• Steroid burst therapy, also known as pulse therapy, refers to the discontinuous intravenous infusion of very high doses of drugs over a short time 4.
• Methylprednisolone and dexamethasone are the most frequently administered glucocorticoids in this manner, with doses ranging from 10 to 20 mg per kilogram of body weight for methylprednisolone and 2 to 5 mg per kilogram of body weight for dexamethasone 4.
• These high doses are usually given as intravenous infusions over 30 minutes to 1 hour daily or every other day for a total of 1 to 5 administrations 4.

Indications and Effects of Steroid Burst Therapy

• Steroid burst therapy is used to treat various conditions, including upper airway obstruction caused by edema from infection, allergy, or trauma, where corticosteroids exert a strong suppressive influence on the basic inflammatory response 5.
• The corticosteroid effect is nonspecific and local, directly proportional to the concentration of steroids in the inflamed tissue 5.
• In the treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD), systemic steroids reduce treatment failure, shorten hospital length of stay, improve lung function, and reduce dyspnea, but the optimal dose is still unclear 6.
• Corticosteroids, such as dexamethasone and methylprednisolone, are also used in the treatment of COVID-19, particularly in moderate, severe, and critically infected patients, due to their potent anti-inflammatory and immunosuppressive effects 7.

Dosage and Monitoring of Steroid Burst Therapy

• The dosage of steroid burst therapy varies depending on the condition being treated, with recommended initial doses for acute airway obstruction being dexamethasone 1.0 to 1.5 mg/kg or methylprednisolone 5 to 7 mg/kg 5.
• The risk of harm from steroid therapy of 24 hours or less is negligible, but longer treatment durations can cause side effects such as hyperglycemia, delirium, fluid retention, and others 5, 6.
• Therapeutic drug monitoring of multiple immunosuppressives, including glucocorticoids, can be performed using liquid chromatography-tandem mass spectrometry (LC/MS/MS) 8.