Asthma Exacerbations Treated With Injectable Dexamethasone Administered Orally

Injectable dexamethasone given orally may be an effective treatment in pediatric patients who present to the emergency department (ED) with asthma exacerbations, according to a study published in the Journal of Pediatric Pharmacology and Therapeutics.

Researchers performed a retrospective study of 99 patients aged 0 to 18 years who presented to, and were discharged from, Moses H. Cone Memorial Hospital ED in Greensboro, North Carolina, with the diagnosis of either asthma or asthma exacerbations, and treated with 1 dose of injectable dexamethasone orally before discharge.

Study results found patients were treated with an average weight-based dose of dexamethasone of 0.35±0.18 mg/kg (range, 0.08-0.62), and an actual dose of 10.58±1.92 mg (range, 5-16 mg).  Follow-up over 30 days found 6% (n=6) of patients returned to the ED, 6% (n=6) were admitted to the hospital, and 3% (n=3) were seen in an outpatient clinic for asthma-related symptoms.

Limitations of this study include its retrospective nature, that it was performed in only 1 hospital, and the lack of comparison between a treatment group and a control group. Data could not be captured with regard to clinic and ED visits outside the hospital healthcare system post ED discharge. In addition, doses of dexamethasone were variable, with many doses given to patients lower than the recommended dose of 0.6 mg/kg.  Surprisingly, many patients were noted to have received 10 mg of dexamethasone regardless of their weight. 

Investigators noted that injectable dexamethasone administered orally to pediatric patients in the ED appeared to be efficacious in preventing a relapse within 30 days. However, a randomized control trial is necessary to compare the efficacy and bioavailability of onetime oral dexamethasone with other formulations and routes of administration. In addition, clinicians should be aware of and use the correct dose of dexamethasone for pediatric patients presenting to the ED with asthma exacerbations.

Reference

McCallister A, So TY, Stewart J. Evaluation of the efficacy of a onetime injectable dexamethasone administered orally in the pediatric emergency department for asthma exacerbation. J Pediatr Pharmacol Ther. 2017;22(5):326-331.