Table 75-8.

Systemic Corticosteroids in the Setting of Asthma Exacerbations

Medication	Adult Dose	Child Dose (≤ 12 Years Old)	Onset of Action	Duration	Comments
Oral—prednisone/ prednisolone IV— methylprednisolone	120-180 mg/day in 3-4 divided doses for 48 hours, then 60-80 mg/day until PEF reaches 70% of predicted or personal best	1 mg/kg every 6 hours for 48 hours, then 1-2 mg/kg/day (maximum, 60 mg/ day) in 2 divided doses until PEF is 70% of predicted or personal best	1-4 hours (variable) 1-4 hours (variable)	12-36 hours	For outpatient burst for 3-10 days: Adult: use 40-60 mg in single or 2 divided doses Children: use 1-2 mg/kg/ day with maximum of 60 mg/day
IM methylprednisolone 40 mg/mL 80 mg/mL	240 mg IM once	7.5 mg/kg IM once	1-4 hours (variable)	36-72 hours	IM should be used in place of a short burst of oral steroids in patients who are vomiting or if adherence is a problem

PEF, peak expiratory flow.

Adapted From National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. Expert Panel Report II: Guidelines for the Diagnosis and Management of Asthma (NIH Publication No. 96-4051). Bethesda, MD, U.S. Department of Health and Human Services, National Institutes of Health, 1997. Available at http://www.nhlbi.nih.gov/guidelines/asthma/asthmafullrpt.pdf.