Oral Corticosteroids:

Acute attack of asthma: treat with short course of 40 to 50mg oral prednisolone* (section 6.3) daily for at least 5 days; longer courses may be required for more severe or recurrent cases.

Acute exacerbation of COPD: consider oral prednisolone* 30mg daily for 5 days in all patients who are admitted to hospital and in those in the community with a significant increase in breathlessness which interferes with daily activities; there is no advantage in treating for longer than 14 days.

Dose tapering: usually doses of up to 40mg daily taken for less than 3 weeks do not need to be tapered and can be stopped abruptly provided the patient is receiving inhaled steroids, however in certain cases they should be tapered; see BNF for more information.

Bone protection: for advice on the need for Bone protection refer to osteoporosis guidance.

*If possible, avoid use of the high-cost prednisolone tablets 25mg and soluble tablets 5mg.

Please consider if a steroid emergency card needs to be given to the patient alongside the traditional steroid treatment card.  This is to support the timely recognition and treatment of potential adrenal crisis and is suitable for some patients on oral, inhaled, topical or rectal steroids.  For more information, including which patients should receive the card, see HIS for details.  Steroid emergency cards have been distributed to, hospitals, GP surgeries and community pharmacies. Primary care can order replacement cards from 01463 706886.

See Peri-operative guidelines for patients with or at risk of adrenal insufficiency

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