EBM Review: Comparative efficacy of oral dexamethasone versus oral prednisone in acute pediatric asthma.

Qureshi F, Zaritsky A, Poirier MP. Comparative efficacy of oral dexamethasone versus oral prednisone in acute pediatric asthma. J Pediatr. 2001 Jul;139(1):20-6.

Full-text for Children’s and Emory users.

OBJECTIVE: The objective was to determine whether 2 days of oral dexamethasone (DEX) is more effective than 5 days of oral prednisone/prednisolone (PRED) in improving symptoms and preventing relapse in children with acute asthma.

STUDY DESIGN: This was a prospective randomized trial of children (2 to 18 years old) who presented to the emergency department with acute asthma. PRED 2 mg/kg, maximum 60 mg (odd days) or DEX 0.6 mg/kg, maximum 16 mg (even days) was used. At discharge children in the PRED group were prescribed 4 daily doses (1 mg/kg/d, maximum 60 mg); children in the DEX group received a prepackaged dose (0.6 mg/kg, maximum 16 mg) to take the next day. The primary outcome was relapse within 10 days.

RESULTS: When DEX was compared with PRED, relapse rates (7.4% of 272 vs 6.9% of 261), hospitalization rates from the emergency department (11% vs 12%) or after relapse (20% vs 17%), and symptom persistence at 10 days (22% vs 21%) were similar. In the PRED group more children were excluded for vomiting in the emergency department (3% vs 0.3%; P =.008), more parents were noncompliant (4% vs. 0.4%; P =.004), and more children missed > or =2 days of school (19.5% vs. 13.2%; P =.05).

CONCLUSION: In children with acute asthma, 2 doses of dexamethasone provide similar efficacy with improved compliance and fewer side effects than 5 doses of prednisone.

Reviewed by Rebecca Sanders, MD and Young Shim, MD

Main Points:

  • For pediatric patients presenting with status asthmaticus (requiring at least 2 nebulized albuterol treatments) no significant difference in relapse rates were noted between 2 days of dexamethasone (0.6 mg/kg) vs 5 days of prednisone (2 mg/kg x 1 then 1 mg/kg x 4 more days) treatment groups
  • People were however more compliant in taking 2 days of dexamethasone compared to PRED (although this did not effect relapse rate)
  • Dexamethasone treatment group were less likely to miss ≥ 2 days of school compared to prednisone group
  • Children were more likely to vomit prednisone (though this analysis was from excluded group)

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