Oral prednisone and dexamethasone are the currently recommended systemic steroids for moderate to severe asthma exacerbations. Formulations such as hydrocortisone and methylprednisolone can be given parenterally. Studies have found these routes to be equally effective, with the oral route being less painful and invasive.10,11 Prednisone is given for 5 days at a dose of 1 to 2 mg/kg daily (maximum 50 mg/d). Dexamethasone can be given for 1 to 5 days at a dose ranging from 0.3 to 0.6 mg/kg daily. Dexamethasone is a long-acting glucocorticoid with a half-life of 36 to 72 hours, and is 6 times more potent than prednisone. Prednisone is shorter acting, with a half-life of 18 to 36 hours.
Recognizing the debate in choice and dose of corticosteroids, the Cochrane Database generated a protocol to investigate this issue in hospitalized patients with asthma, but a review has not yet been published.