For children taken to the emergency department for an asthma exacerbation, a one-time dose of dexamethasone may be superior to existing pediatric asthma management therapy prednisone/prednisolone, according to an article published by Medpage Today.
The most recent randomized clinical trial to address the question of oral dexamethasone versus prednisone/prednisolone was published by Cronin and colleagues in 2016. This was done in an ED setting in Ireland and involved children ages 2 to 16 years; 245 patients were analyzed. The dosing schedule was different from the prior studies of oral dexamethasone. The dose of dexamethasone was 0.3 mg/kg — which is half of what was given in the other trials — and the dose of prednisolone was 1 mg/kg — again half the dose in the other trials.
The dexamethasone was given as a single dose in the ED, and the prednisolone was given over 3 days, as opposed to 5 days in the other trials. The primary outcome was asthma scores on day 4, which were no different between the two groups. Hospitalization rates and unscheduled return visits were also not different; 14 children vomited with the prednisolone versus none of the dexamethasone patients.
Some caution is needed, however. Although there are currently six randomized trials showing dexamethasone to be just as good as prednisone/prednisolone, three gave the dexamethasone IM, one gave 2 days of oral dexamethasone, and only two of the trials used a single ED dose. Of those two, one was small, and the other used lower doses than are standard in the US.