Table 7.

Current guideline recommendations for corticosteroids in severe asthma exacerbations

Guideline (reference)	GINA [47]	ATS [54]	BTS [53]	Swiss [52]	NAEPP [55]	Japan [56]	TSANZ [57]
Drug	Prednisone	Prednisone	Prednisone	Prednisone	Prednisone	prednisone	Prednisone
Dose in mg	40	37.5–50	40–50	40–50	40	0.5 mg/kgb	40
Duration	Up to 7 days°	7 days	Until recovery (minimum 5 days)	5–7 days	Up to 7 daysa	Usually less than 7 days	5–10 days
Year	2022	2019	2019	2018	2020	2020	2021

^aIn patients failing to respond to inhaler therapy escalation over 3 days, for those who rapidly deteriorate, or for people with a history of brittle exacerbations. Severe exacerbation is objectively characterized by respiratory rate > 30/min, heart rate > 120/min, PEF < 50% pred or best, SpO₂ < 90%, or use of accessory respiratory muscles. A life-threatening event additionally shows drowsiness, mental confusion, or a silent chest

^bIn an emergency intravenous drip infusion of 200–500 mg of cortisol or 40–80 mg of methylprednisolone every 4–6 h as needed is possible until passage to oral formulations