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Single-Dose Oral Dexamethasone in the Emergency Management of Children With Exacerbations of Mild to Moderate Asthma

Altamimi, Saleh MD, FRCP(C), FAAP; Robertson, Glenn MD, FRCP(C), UBC; Jastaniah, Wasil FRCP(C), UBC; Davey, Allyson MD, FRCP(C); Dehghani, Navid MD, FRCP(C), UBC; Chen, Ruth RN, MSN; Leung, Karen BSc, Phm; Colbourne, Margaret MD, FRCP(C), UBC

doi: 10.1097/01.pec.0000248683.09895.08
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Objective: To compare the efficacy of a single dose of oral dexamethasone (Dex) versus 5 days of twice-daily prednisolone (Pred) in the management of mild to moderate asthma exacerbations in children.

Study Design: A prospective, randomized, double-blinded trial of children 2 to 16 years of age who presented to the emergency department (ED) with acute mild to moderate asthma exacerbations. Subjects received single-dose oral Dex (0.6 mg/kg to a maximum of 18 mg) or oral Pred (1 mg/kg per dose to a maximum of 30 mg) twice daily for 5 days. After discharge, subjects were contacted by telephone at 48 h to assess symptoms and reevaluated in the ED in 5 days. The primary outcome was the number of days needed for Patient Self Assessment Score to return to baseline (score of 0-0.5).

Main Results: Baseline characteristics of the 2 groups were similar. The mean number of days needed for Patient Self Assessment Score to return to baseline (0-0.5) in the Dex and Pred groups were 5.21 versus 5.22 days, respectively (mean difference, −0.01; confidence interval, −0.70, 0.68). Pulmonary index scores were similar in both groups at initial presentation, initial ED discharge and at the day 5 follow-up visit. At the first visit, mean time to discharge was 3.5 h (±1.93)for Dex and 4.3 h (±3.67) for Pred (mean difference, −0.8; confidence interval, −1.8, 0.2). Initial admission rate was 9% (Dex) versus 13.4% (Pred). There was no significant difference in the number of salbutamol therapies needed in the ED nor at home after discharge. For subjects discharged home, the admission rate after initial discharge was 4.9% (Dex) versus 1.8% (Pred), resulting in overall hospital admission rates of 13.4% (Dex) and 14.9% (Pred).

Conclusion: A single dose of oral Dex (0.6 mg/kg) is no worse than 5 days of twice-daily prednisolone (1 mg/kg per dose) in the management of children with mild to moderate asthma.

Division of Emergency Medicine, Department of Pediatrics, University of British Columbia (U.B.C.) and British Columbia's Children's Hospital, Vancouver, B.C., Canada.

Address correspondence and reprint requests to Margaret Colbourne, MD, FRCP (C), UBC, Emergency Department, British Columbia Children's Hospital, 4480 Oak St., Vancouver, B.C., Canada V4M 4C7. E-mail: mcolbourne@cw.bc.ca.

© 2006 Lippincott Williams & Wilkins, Inc.