Original articlesComparative efficacy of oral dexamethasone versus oral prednisone in acute pediatric asthma☆
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)
- et al.
Intramuscular methylprednisolone acetate for the prevention of relapse in acute asthma
Ann Emerg Med
(1993) - et al.
Comparison of intramuscular triamcinolone and oral prednisone in the outpatient treatment of acute asthma: a randomized controlled trial
Ann Emerg Med
(1998) - et al.
Early intervention with short courses of prednisone to prevent progression of asthma in ambulatory patients incompletely responsive to bronchodilators
J Pediatr
(1987) - et al.
Factors associated with relapse after emergency department treatment for acute asthma
Ann Emerg Med
(1995) - et al.
Nontapering versus tapering prednisone in acute exacerbations of asthma: a pilot trial
J Emerg Med
(1995) - et al.
Nebulized dexamethasone versus oral prednisone in the emergency treatment of asthmatic children
Ann Emerg Med
(1995) - et al.
Oral vs repository corticosteroid therapy in acute asthma
Chest
(1988) - et al.
Patient noncompliance with medical advice after the emergency department visit
Ann Emerg Med
(1996) Patient compliance in filling prescriptions after discharge from the emergency department
Am J Emerg Med
(1987)- et al.
Efficacy of nebulized ipratropium in severely asthmatic children
Ann Emerg Med
(1997)
Ventilatory functions of normal children and young adults—Mexican-American, white, and black. I. Spirometry
J Pediatr
Effectiveness of steroid therapy in acute exacerbations of asthma: a meta-analysis
Am J Emerg Med
Rapid improvement of peak flow in asthmatic patients treated with parenteral methylprednisolone in the emergency department: a randomized controlled study
Ann Emerg Med
A single dose of intramuscularly administered dexamethasone acetate is as effective as oral prednisone to treat asthma exacerbations in young children
J Pediatr
Intravenous versus oral corticosteroids in the management of acute asthma in children
Ann Emerg Med
Oral versus intravenous corticosteroids in children hospitalized with asthma
J Allergy Clin Immunol
Corticosteroids for exacerbations of asthma: problems and solutions [editorial]
J Pediatr
Surveillance for asthma: United States. 1960-1995
MMWR Morb Mortal Wkly Rep
Guidelines for the diagnosis and management of asthma
Cited by (0)
- ☆
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.