Corticosteroid Treatment for Bronchial Asthma Exacerbation

Dosing Recommendations

The British Medical Journal recommends prednisolone 30-40 mg daily for adults with asthma exacerbations 1, 2, 3
For children, the recommended dose is 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 4
Treatment should continue until lung function values have returned to previous best 1, 2, 3
Though 7 days' treatment will often be sufficient, treatment may need to be continued for up to 21 days in some cases 1, 2, 3
Short courses of oral steroids (up to two weeks) do not need to be tapered; oral steroids can be stopped from full dosage 1, 2, 3

Oral administration is preferred as intravenous administration offers no advantages 1, 2
For patients who are seriously ill or vomiting, intravenous hydrocortisone 200 mg every six hours can be used 5

Day-by-day worsening of symptoms and peak expiratory flow to below 60% of patient's best 1, 3
Sleep disturbance till midday 1, 3
Diminishing response to inhaled bronchodilators 1, 3
Emergency use of nebulized or injected bronchodilators 1, 3

Measure and record peak expiratory flow 15-30 minutes after starting treatment and thereafter according to response 5
Continue high doses of steroids until improvement is noted 5
Treatment should continue until lung function values have returned to previous best 1, 2, 3

Corticosteroid treatment provides important benefits to patients presenting with acute exacerbations of asthma 1, 2, 3
Short courses of oral steroids produce very low rates of gastrointestinal bleeding, with the greatest risk in patients with a history of gastrointestinal bleeding or those taking anticoagulants 1, 2, 3

All patients should be discharged taking prednisolone tablets (30 mg daily or more) for one to three weeks 6
Patients should be offered education about their condition and its management 1, 3

The American Academy of Allergy, Asthma, and Immunology recommends continuing systemic corticosteroids until peak expiratory flow (PEF) reaches 70% of predicted or personal best, which typically requires 5-10 days of treatment 7
The total course for exacerbations requiring emergency department visits or hospitalization typically lasts 3-10 days 7
Tapering is only necessary for courses exceeding 2 weeks, particularly if patients are NOT concurrently taking inhaled corticosteroids 7
For courses slightly longer than 10 days (e.g., up to 2 weeks), there is probably no need to taper, especially if patients are using inhaled corticosteroids 7

Patients with a history of frequent exacerbations have high reexacerbation rates (80-86%) regardless of tapering strategy 7