Prednisone for Asthma: Does It Work?

Prednisone works on the immune system to lower inflammation in the airways of people with asthma. It takes a few hours to begin working and usually must be taken for multiple days to prevent the inflammation from returning.

Prednisone is a man-made anti-inflammatory drug approved by the Food and Drug Administration (FDA). It’s a delayed-release corticosteroid derived from the hormone cortisone and is available as an oral tablet or liquid.

Doctors commonly prescribe the medication for short courses, such as when someone requires care in an emergency department or is admitted to the hospital for an asthma attack.

It may also be used long term in people whose asthma is severe or difficult to control.

How well does prednisone treat asthma?

Prednisone reduces inflammation in the lungs and also decreases mucus production. It’s an effective option for treating acute asthma and continues to exert an anti-inflammatory effect in the days after a flare-up.

Typically, treatment lasts 5 to 10 days  to lessen symptoms of an exacerbation. A 2021 Australia and New Zealand study  found that oral corticosteroids such as prednisone reduce asthma-related emergency visits and hospital stays.

If you need prednisone more than a couple of times a year, discuss alternative management strategies with your clinician to better control your asthma, and consider options like saba asthma information when relevant.

What side effects can occur?

Although oral corticosteroids can relieve asthma symptoms effectively, they may also produce notable side effects.

Reported side effects of prednisone include :

• fluid retention
• elevated blood pressure
• altered blood sugar levels
• weight gain
• nausea, vomiting, and diarrhea
• mood or behavioral shifts
• trouble sleeping
• heightened infection risk due to immune suppression
• bone thinning (osteoporosis)
• eye issues such as glaucoma or cataracts
• potential negative impact on growth or development in children

Many of these adverse effects, like osteoporosis and eye problems, are more common with prolonged use. However, there is some limited evidence  suggesting certain effects may appear even after a short course. In particular, brief use has been associated with:

• osteopenia (loss of bone density)
• increased blood pressure
• gastrointestinal ulcers and bleeding

Short-term courses have also been linked to vomiting and behavioral or psychological issues in children. For these reasons, clinicians are advised to prescribe prednisone and other corticosteroids only when clearly indicated.

What dose will I take?

In adults, common dosing ranges from 5 to 60 milligrams (mg) , depending on what proves most effective for the individual.

Prednisone is provided orally as tablets or a liquid in the United States. It is similar to but not identical with methylprednisolone, which is available as an injectable and an oral form. Oral prednisone is commonly used as a first-line therapy  for acute asthma.

If you miss a dose of prednisone, take it as soon as you remember. If it’s almost time for the next scheduled dose, skip the missed dose and continue with the usual dosing. Do not take an extra dose to make up for one you missed. To reduce stomach upset, it’s preferable to take prednisone with food or milk.

Discuss with your doctor how much prednisone you should take following an asthma flare-up. The regimen will depend on your age and the severity of your condition.

Questions to discuss with your doctor

Prednisone is not considered safe during pregnancy. Inform your clinician right away if you become pregnant while taking prednisone.

Because prednisone weakens the immune response, you may be more susceptible to infections. Talk to your doctor if you have an infection or have recently received a vaccine.

Some drugs can interact adversely with prednisone. Share a complete list of your medications with your clinician. Mention if you are taking any of the following  classes:

• anticoagulants (blood thinners)
• diabetes treatments
• anti-tuberculosis medications
• macrolide antibiotics such as erythromycin (E.E.S.) or azithromycin (Zithromax)
• cyclosporine (Sandimmune)
• estrogen-containing drugs, including hormonal contraceptives
• nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin
• diuretics
• anticholinesterase agents, especially in people with myasthenia gravis

Alternative treatments

Other anti-inflammatory agents may play a role  in asthma care. Examples include:

Inhaled corticosteroids

Inhaled corticosteroids are highly effective at decreasing airway inflammation and mucus. They’re usually taken twice daily and are delivered via a metered-dose inhaler, dry powder inhaler, or nebulizer solution.

These medications are preventive — they help stop symptoms from occurring rather than treating an active attack.

At low doses, inhaled corticosteroids have minimal side effects. At higher doses, rare complications such as an oral fungal infection (thrush) can occur.

Mast cell stabilizers

Mast cell stabilizers prevent certain immune cells (mast cells) from releasing histamine and other inflammatory mediators. They’re useful in preventing symptoms, especially in children and people whose asthma is triggered by exercise.

These drugs are typically taken two to four times a day and have few side effects; the most frequent is a dry throat.

Leukotriene modifiers

Leukotriene modifiers are a more recent class of asthma medicines. They block leukotrienes — naturally occurring compounds that can cause airway muscle constriction.

These oral medications are usually taken one to four times daily. The most common side effects are headache and nausea.

Bottom line

Prednisone is a corticosteroid commonly used for acute asthma episodes. It helps reduce airway inflammation in people experiencing an asthma attack and has been shown to decrease the chance of recurrent acute symptoms after an emergency department visit or hospitalization.

Many of the significant side effects linked with prednisone occur with long-term use, though some risks may appear even after short courses. Prednisone can interact with multiple other medications, so it’s essential to tell your healthcare provider about all the medicines you take before beginning prednisone.