Single-Dose Oral Dexamethasone for Asthma Exacerbations in Children
The Article: Altamimi, Saleh, et al. “Single-dose oral dexamethasone in the emergency management of children with exacerbations of mild to moderate asthma.” Pediatric emergency care 22.12 (2006): 786-793.
The Idea: Compare single-dose oral dexamethasone versus multidose prednisolone to determine if one-time dose of 0.3mg/kg dexamethasone in the emergency room can result in better resolution of symptoms on day 4 when compared to 1mg/kg of prednisolone for 3 days. Key metric was PRAM (Pediatric Respiratory Assessment Measure) which measures work of breathing, air entry, wheezing, and oxygen saturation.
The Study: Pediatric tertiary ED visits for mild to moderate asthma exacerbations in Ireland were randomized to receive either 0.3mg/kg of oral dexamethasone once in the emergency room or 1mg/kg of prednisolone for 3 days and record symptoms by a physician with a follow-up visit on day 4.
The Findings: Single-dose dexamethasone treatment group had no difference in mean PRAM scores at day 4 when compared to daily prednisolone (0.91 vs. 0.91). Based on sample size of 245 enrollments in 226 patients randomized patients, the difference was not significant. Prednisolone had higher rates of vomiting but dexamethasone had higher rates of receiving further systemic steroids within 14 days. There was no difference in hospital admission rates or return visits between the two groups.
The Takeaway: For children presenting to a emergency room with asthma exacerbations, single-dose 0.3mg/kg oral dexamethasone is non-inferior to a 3-day course of prednisolone as measured by PRAM score on day 4.