Systemic corticosteroids are recommended in clinical practice guidelines for the treatment of acute asthma exacerbation based on evidence demonstrating reduced hospitalizations and improved outcomes after administration in the emergency department. Although prednisone and related oral preparations have been recommended previously, researchers have assessed dexamethasone as an alternative based on its longer biologic half-life and improved palatability. Systematic reviews of multiple small trials and 2 larger trials have found no difference in revisits to the emergency department compared to prednisone for dexamethasone given either as an intramuscular injection or orally. Studies of oral administration have found reduced emesis for dexamethasone compared to prednisone both in the emergency department and for a second oral dose, typically given 24 to 48 hours later. Studies assessing a single dose of dexamethasone have found equivalent improvement at follow-up but with some evidence of increased symptoms and increased need for additional corticosteroids compared to multiple doses of prednisone. Future research could further assess dexamethasone dose, formulation, and frequency and measure other related adverse effects such as behavior change. Consideration of baseline differences within the heterogeneous population of children requiring acute care for asthma may also guide the design of an optimal dexamethasone regimen.
*Assistant Professor of Pediatrics (Abaya), Pediatric Emergency Medicine, Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, †Clinical Pharmacist (Jones), The Children’s Hospital of Philadelphia, Philadelphia, PA, and ‡Professor of Pediatrics (Zorc), Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA.
The authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interest in, any commercial organizations pertaining to this educational activity.
Reprints: Ruth Abaya, MD, MPH, Assistant Professor of Pediatrics, Division of Emergency Medicine, Pediatric Emergency Medicine, The Children’s Hospital of Philadelphia, 3501 Civic Center Blvd, 9th floor, Philadelphia, PA 19104 (e-mail: firstname.lastname@example.org).