Prednisone acute asthma exacerbations

Park CL, Frank AL, Sullivan M, Jindal P, Baxter BD. Influenza vaccination of children during acute asthma exacerbation and concurrent prednisone therapy. Pediatrics 1996 98(2 Pt l) 196-200. 

Systemic glucocorticoids are used for acute asthma exacerbations and chronic severe asthma. Substantial doses of glucocorticoids (e.g., 40-60 mg prednisone or equivalent daily for 5 days ... 

The corticosteroids are effective in most children and adults with asthma. They are beneficial for the treatment of both acute and chronic aspects of the disease. Inhaled corticosteroids, including triamcinolone ace-tonide (Azmflcort),beclomethasone dipropionate (Beclo-vent, Vancerit), flunisolide AeroBid), and fluticasone (Flovent), are indicated for maintenance treatment of asthma as prophylactic therapy. Inhaled corticosteroids are not effective for relief of acute episodes of severe bronchospasm. Systemic corticosteroids, including prednisone and prednisolone, are used for the short-term treatment of asthma exacerbations that do not respond to (32-adrenoceptor agonists and aerosol corticosteroids. Systemic corticosteroids, along with other treatments, are also used to control status asthmaticus. Because of the side effects produced by systemically administered corticosteroids, they should not be used for maintenance therapy unless all other treatment options have been exhausted. 

The effect of supplementary inhaled budesonide in acute asthma has been evaluated in a randomized, double-blind comparison with standard treatment in 44 children aged 6 months to 18 years with a moderate to severe exacerbation of asthma (26). Prednisone 1 mg/kg orally and nebulized salbutamol (0.15 mg/kg) every 30 minutes for three doses and then every hour for 4 hours were given to all children. In addition, each child was given 2 mg of nebulized budesonide or nebulized isotonic saline. There was a more rapid discharge rate in the budesonide group. There were no adverse effects. The authors concluded that nebulized budesonide may be an effective adjunct to oral prednisone in the management of moderate to severe exacerbations of asthma. 

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