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Sample Topic: Asthma

Asthma : Last revised in December 2013


Oral corticosteroids

Prescribing oral corticosteroids

  • Adverse effects are uncommon with infrequent, short courses of oral corticosteroids.
  • Table 1 below shows the dose of oral prednisolone recommended in an acute exacerbation of asthma:
    • In adults, oral corticosteroids should be continued for at least 5 days, until recovery.
    • In children, oral corticosteroids should be continued for at least 3 days, until recovery.
    • Prescribe soluble prednisolone tablets for children who cannot swallow tablets.
    • Repeat the dose of prednisolone in children who vomit.
  • After recovery from the acute exacerbation, therapy with prednisolone can be stopped abruptly, without tapering the dose, unless the course was longer than 3 weeks or the person was previously receiving maintenance oral corticosteroid treatment.

Table 1. Dose of oral prednisolone used in acute severe exacerbation of asthma.

Dose of oral prednisolone (once daily) < 2 years old 2–5 years old 6–12 years old > 12 years old
People not taking regular oral corticosteroid 10 mg 20 mg 30–40 mg 40–50 mg*
People taking regular oral corticosteroid 2 mg/kg (maximum 40 mg) 2 mg/kg
(maximum 60 mg)
2 mg/kg
(maximum 60 mg)
2 mg/kg
(maximum 60 mg)
* In practice, many healthcare professionals prescribe 30 mg/day.
Data from: [BNF 53, 2007; BNF for Children, 2007; SIGN and BTS, 2011]

What are the adverse effects of continuous or frequent use of oral corticosteroids and how can they be managed?

  • The risk and severity of adverse effects with oral corticosteroids increase with the dose and the duration of treatment. People receiving long-term oral corticosteroids (more than 3 months) or those needing frequent courses of an oral corticosteroid (three to four per year) are at risk of systemic adverse effects.
  • Systemic adverse effects include osteoporosis, hypertension, diabetes, hypothalamic–pituitary–adrenal axis suppression, weight gain, cataracts, glaucoma, skin-thinning, easy bruising, and muscle weakness.
  • Aim to prevent, minimize, or quickly detect adverse effects of long-term corticosteroids. General and lifestyle recommendations to minimize adverse effects include the following:
    • Encourage adequate dietary calcium intake and good nutrition.
    • Maintain normal body weight where possible.
    • Advise on smoking cessation.
    • Advise on moderate alcohol consumption.
    • Encourage physical exercise within the limits imposed by the underlying disease.
    • Perform a falls risk assessment, where appropriate, and advise those at increased risk of fractures from falling.
  • Monitor, prevent, and treat the systemic adverse effects of continuous or frequent courses of oral corticosteroids:
    • Blood pressure: monitor regularly and treat if necessary.
    • Diabetes mellitus: screen regularly and treat if necessary.
    • Osteoporosis: see the Prodigy topic on Osteoporosis – prevention of fragility fractures for details on when to prescribe prophylactic bisphosphonate therapy.
    • Growth suppression: record height of children regularly and accurately.
    • Cataracts: screen children periodically through community optometric services.
  • Children who frequently use courses of oral corticosteroids should have regular checks for signs of adrenal suppression. Refer to a paediatrician who can arrange Synacthen® testing, where appropriate.
  • Document the person’s history of chickenpox (fatal disseminated chickenpox may occur in non-immune people). Advise all people without a history of chickenpox who are taking systemic prednisolone to avoid close contact with people who have chickenpox or shingles, and to seek urgent medical advice if they are exposed.