Original articles
Comparative efficacy of oral dexamethasone versus oral prednisone in acute pediatric asthma

https://doi.org/10.1067/mpd.2001.115021Get rights and content

Abstract

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 ≥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. (J Pediatr 2001;139:20-6)

Section snippets

Study Population

The study group consisted of children 2 to 18 years old with a known history of asthma (2 or more episodes of wheezing treated with β-adrenergic agonists ± steroids) who presented to the pediatric ED with an acute exacerbation, defined as worsening of their asthmatic symptoms or increased difficulty in breathing with worsening of their peak expiratory flow rates. Children <2 years old were not enrolled to avoid including patients with bronchiolitis.

Children were considered for the study if they

RESULTS

Patient enrollment data are shown in the Figure. Patients could be enrolled more than once provided they had not used oral corticosteroids in the 4 weeks before the current episode. Approximately 8% of patients were included more than once. Of the 1231 eligible children, 628 were enrolled and 533 (272 in the DEX group and 261 in the PRED group) completed the study. As shown in the Figure, significantly more enrolled children were excluded for vomiting in the PRED group than in the DEX group (3%

DISCUSSION

This prospective, randomized, clinical trial found that the relapse rate in children with acute asthma was not different when 2 doses of oral DEX (dispensed in the ED) were compared with 5 doses of oral PRED (1 dispensed in the ED and 4 prescribed home doses). There also was no difference in symptom improvement or the rate of hospitalization.

Because corticosteroids improve pulmonary function, reduce the rate of hospitalization, and decrease the relapse rates in patients with acute asthma

Acknowledgements

We thank Drs Daniel Isaacman, Kathleen Doobinin, Theresa Guins, Michele Wadsworth, Jennifer Trainor, Alan Causey, Anita Maniktala, Craig Huang, and the emergency department staff for their help with patient enrollment. We also thank Bonnie Burke for her statistical support, Nermina Nakas for data entry, and Cindy Buckler for assistance with preparing this manuscript.

References (38)

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Reprint requests: Faiqa Qureshi, MD, Division of Pediatric Emergency Medicine, Children’s Hospital of The King’s Daughters, 601 Children’s Ln, Norfolk, VA 23507.

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