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Randomized Trial of Single-Dose Intramuscular Dexamethasone Compared With Prednisolone for Children With Acute Asthma

Gordon, Stephen MD; Tompkins, Tameko MS; Dayan, Peter S. MD, MSc

doi: 10.1097/PEC.0b013e318128f821
Original Articles

Objectives: To compare the clinical efficacy of single-dose intramuscular (IM) dexamethasone phosphate to a 5-day course of oral prednisolone for the treatment of moderate asthma exacerbations in young children discharged from the emergency department (ED).

Methods: We performed a prospective, randomized trial in children aged 18 months to less than 7 years with asthma who presented to the ED with a clinical asthma score of 3 to 7 on a 9-point scale. Children were randomized to 1 dose of IM dexamethasone (0.6 mg/kg, maximum 15 mg) or oral prednisolone (2 mg/kg, maximum 50 mg) once daily for 5 days. The primary outcome, measured only for patients discharged from the ED, was change in asthma score from ED presentation to 4-day follow-up examination, as assessed by a physician masked to group assignment. We assessed secondary clinical course outcomes by a structured interview at 4 and 14 days.

Results: Eighty-eight patients were appropriately randomized to dexamethasone and 93 to prednisolone. Group characteristics were similar at baseline. Among those discharged from the ED, 62 (90%) of 69 and 64 (90%) of 74 patients in the dexamethasone and prednisolone groups, respectively, were reassessed at 4 days for the primary outcome. The mean change in total asthma score at 4-day follow-up was 3.6 in the dexamethasone group and 3.4 in the prednisolone group (difference, 0.2; 95% confidence interval, −0.4 to 0.7). Of patients initially discharged, 5.9% of dexamethasone patients and 4.1% of prednisolone patients were admitted before the 2-week follow-up (difference, 1.8%; 95% confidence interval, −5.4% to 9.0%).

Conclusions: A single dose of IM dexamethasone showed no clinically meaningful difference in outcomes compared with a 5-day course of oral prednisolone for the treatment of moderate acute asthma exacerbations in young children who are discharged from the ED.

Columbia University College of Physicians and Surgeons, The Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY.

Presented at the American Academy of Pediatrics Annual Conference New Orleans, LA, October 2003.

Address correspondence and reprint requests to Stephen Gordon, MD, The New York Presbyterian Hospital, 622 W 168th St, PH 137, New York, NY 10032. E-mail: stlgordon@gmail.com.

© 2007 Lippincott Williams & Wilkins, Inc.