What role do oral corticosteroids play in the management of acute asthma exacerbations, and when should they be initiated?

The role of oral corticosteroids in the management of acute asthma exacerbations is to reduce mortality, relapses, subsequent hospital admission, and the requirement for beta-2 agonist therapy. The earlier corticosteroids are given in an acute exacerbation, the better the outcome ¹.

They should be initiated immediately as a first-line treatment during an exacerbation. A first dose of oral prednisolone (40-50 mg for adults and children 16 years and over; 30-40 mg for children 6–15 years; 20 mg for children 2–5 years; or 10 mg for children under 2 years) should be given immediately, if oral administration is possible ¹.

If oral administration is not possible, alternative routes such as intramuscular methylprednisolone or intravenous hydrocortisone should be used. The course typically lasts for at least 5 days in adults and up to 3 days in children, but may be extended until full recovery if needed ¹.