Management of Severe Asthma with Corticosteroids

Initial Treatment and Dosing

• The British Thoracic Society guidelines recommend IV hydrocortisone 200 mg immediately, then 200 mg every 6 hours for patients who are vomiting or severely ill 1
• Methylprednisolone 125 mg is roughly equivalent to hydrocortisone 500 mg in anti-inflammatory potency 1

Assessment of Clinical Improvement

• Peak expiratory flow reaching >50% predicted is a marker of clinical improvement 2
• Respiratory rate <25 breaths/min is a marker of clinical improvement 2
• Ability to speak in full sentences is a marker of clinical improvement 2
• SpO2 >92% on supplemental oxygen is a marker of clinical improvement 1

Transition to Oral Therapy

• Once the patient can tolerate oral intake and shows clinical improvement, transition to oral prednisone 40-60 mg daily 1
• Oral corticosteroids are equally effective as IV therapy when GI absorption is intact 1
• Continue oral therapy for 5-10 days total until peak flow reaches ≥70% predicted 1

Concurrent Therapy

• High-flow oxygen to maintain SpO2 >92% should be administered 1
• Nebulized salbutamol 5 mg (or terbutaline 10 mg) every 20-30 minutes initially should be administered 1
• Add ipratropium 0.5 mg to nebulizers if inadequate response after 15-30 minutes 1, 2