Two doses of dexamethasone may be an effective alternative to a 5-day course of prednisolone/prednisone for asthma exacerbations in children, as measured by persistence of symptoms and quality of life (QOL) at day 7, according to a study published in The Journal of Pediatrics.
The researchers conducted a randomized, noninferiority trial that included patients between the ages of 1 and 14 years who were seen in the emergency department (ED) for acute asthma. Patients were randomly assigned to 2 doses of dexamethasone (0.6 mg/kg/dose) or conventional treatment — a 5-day course of prednisolone/prednisone (1.5 mg/kg/d on the first day, followed by 1 mg/kg/d on days 2-5).
The primary outcome measures were the percentage of patients with asthma symptoms and QOL on day 7. Secondary outcomes included unscheduled returns, admissions, adherence, and vomiting. Follow-up telephone interviews were conducted on days 7 and 15.
A total of 557 patients completed the trial. Investigators found no significant differences related to persistence of symptoms (56.6% vs 58.3% for experimental and conventional groups, respectively), QOL score (80.0 vs 77.7), admission rates (23.9% vs 21.7%), unscheduled ED return visits (4.6% vs 3.3%), or vomiting (2.1% vs 4.4%). The only significant difference was adherence, which was 99.3% in the dexamethasone group compared with 96.0% in the conventional group (P <.05).
One study limitation was the open-label design, which may affect the trial’s internal validity, although both the data managers and the statistical team were blinded. The single urban ED setting may limit the generalizability of the results, and both primary outcomes — asthma symptoms and QOL on day 7 — were subjective measures. Furthermore, 43% of the children were under the age of 5 years, which presents a disadvantage for self-reported symptoms. Patients with critical or life-threatening exacerbations were excluded from the study, as were older adolescents.
Paniagua N, Lopez R, Muñoz N, et al. Randomized trial of dexamethasone versus prednisone for children with acute asthma exacerbations. J Pediatr. 2017;191:190-196.