1. A shorter course of dexamethasone, when compared to longer duration prednisone/prednisolone treatment for pediatric asthma exacerbation, showed no difference in terms of relapse rate.
2. Dexamethasone had a significantly lower incidence of vomiting when compared to prednisone/prednisolone, both in the Emergency Department and later at home.
Evidence Rating Level: 1 (Excellent)
Study Rundown: In addition to inhaled bronchodilators, a short course of corticosteroids is standard therapy for treating pediatric asthma exacerbations. A 5-day course of prednisone or prednisolone is currently the most common choice of corticosteroid treatment, though some small studies have recently looked at shorter courses with dexamethasone. This systematic review article identified 6 randomized control trials comparing short course regimens of dexamethasone with longer courses of prednisone/prednisolone in pediatric patients presenting for asthma exacerbation. Rates of unscheduled return to Emergency Department (ED) or clinic after initial visit and incidence of vomiting were measured. No significant differences were found between dexamethasone and prednisone/prednisolone in terms of relapse rate. Dexamethasone was associated with lower rates of vomiting both in the ED and at home. This systematic review was limited by potential selection bias and the quality of included studies. It suggests, however, that shorter courses of dexamethasone may be equally efficacious and with less side effects than the current standard steroid treatment of prednisone/prednisolone for asthma exacerbations.
Relevant Reading: AAP Asthma, Allergy, and Immunology Clinical Guidelines
In-Depth [systematic review]: This systematic review and meta analysis included 6 randomized control trials from the United States and Canada assessing use of dexamethasone versus prednisone/prednisolone for treatment of pediatric asthma exacerbations in the ED. All trials excluded patients whose asthma exacerbation was severe enough to warrant. Dexamethasone was administered either orally or intramuscularly, in single or 2-dose form. Prednisone/prednisolone was given orally in a 5-day course. Relapse rate, as defined by unscheduled presentation to clinic or ED after initial visit, was calculated. The relative risk (RR) of relapse at 5 days with dexamethasone in comparison to prednisone/prednisolone showed no significant difference at 0.90 (95% CI: 0.46 – 1.78). A 30-day RR was similarly not significant at 1.20 (95% CI: 0.03 – 56.93). Incidence of vomiting, either in the ED or later at home, was significantly decreased with dexamethasone (RR = 0.29, 95% CI = 0.12 – 0.69), but it was not clear whether this was due to a chemical difference or the taste of the medication.
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