Dexamethasone for Adult Asthma Exacerbations
Rehrer, Matthew W., et al. “A Randomized Controlled Noninferiority Trial of Single Dose of Oral Dexamethasone Versus 5 Days of Oral Prednisone in Acute Adult Asthma.” Annals of emergency medicine (2016).
Compare oral dexamethasone to five days of prednisone to determine if one-time dose of dexamethasone in the emergency department is not inferior to 5-day prednisone course. Key metric was relapse rate of an unscheduled return visit within 14 days of initial visit.
Adult emergency department patients with mild to moderate asthma exacerbations were randomized to receive either 5-day course of 60mg prednisone or one-time dose of 12mg dexamethasone with 4 days of placebo.
Dexamethasone had a slightly higher 14-day relapse visit rate when compared to 5-day course of prednisone (12.1% vs 9.8%). Based on the sample size of 376 patients, this difference was large enough that the authors were not able to demonstrate noninferiority of dexamethasone to prednisone. Patients receiving the medications had similar rates of hospitalizations (3.4% for dexamethasone and 2.9% for prednisone) and adverse effects.
For minor or moderate adult asthma exacerbations, single-dose oral dexamethasone is similar or slightly inferior to a 5-day course of oral prednisone.