Initial corticosteroid dose for acute asthma

Q: A 42-year-old patient with previous history of asthma exacerbations is readmitted to ICU and is on ventilator now. A massive initial dose of methylprednisolone 500 mg intravenous bolus is indicated to shorten the course.

A) True

B) False

Answer: B

Interestingly, despite such a long interaction with this disease process, the optimal dose for systemic glucocorticoids in asthma exacerbations remained unknown!

Clinicians have used a wide range of methylprednisolone, from 20 to 500 mg, as an initial dose. Studies have shown that methylprednisolone 500 mg intravenous initial bolus is no better than 125 mg and actually is not recommended.

Subsequent doses may range from 40 to 80 mg (oral or IV) every 6 to 12 hours till symptoms improve.

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References:

1. Normansell R, Kew KM, Mansour G. Different oral corticosteroid regimens for acute asthma. Cochrane Database Syst Rev 2016; :CD011801.

2. McFadden ER Jr. Acute severe asthma. Am J Respir Crit Care Med 2003; 168:740.

3. Emerman CL, Cydulka RK. A randomized comparison of 100-mg vs 500-mg dose of methylprednisolone in the treatment of acute asthma. Chest 1995; 107:1559..