3.2.5 Systemic Steroids

• Acute attacks of asthma should be treated with short courses of 40mg to 50mg prednisolone daily, reducing once the attack has been controlled. For example, a standard course could be 40mg daily for at least 5 days or until recovery. Usually doses of up to 40mg daily taken for less than 3 weeks can be stopped abruptly but in certain cases they should be tapered – see BNF for more information. Patients requiring 3 courses or more in a year should be referred to secondary care.
• For an exacerbation of COPD, recommended courses include oral prednisolone 30mg per day for 5 days.
• For information on antibiotic choices in the management of exacerbations of COPD see NI Management of Infections Guidelines for Primary Care.
• If a patient is receiving more than three to four courses of oral steroids per year, they should be given a steroid card and considered for bone protection. Refer to Frax or QFracture.
• A Steroid Emergency Card for Northern Ireland has been developed in response to the National Patient Safety Alert that was issued in August 2020. The alert highlights the dangers associated with adrenal insufficiency for patients taking corticosteroid medication, and recommends that all eligible patients prescribed (or initiated on) steroids are assessed and where necessary issued with a Steroid Emergency Card. Community pharmacies and GP practices can order these from pharmacystationeryorders@hscni.net.
• With regard to gastrointestinal effects, there is no advantage in using enteric coated prednisolone tablets; plain tablets should be used.