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Randomized trial of single-dose intramuscular dexamethasone compared with prednisolone for children with acute asthma
Stephen Gordon1, Tameko Tompkins, Peter S Dayan
1Columbia University College of Physicians and Surgeons, The Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY, USA. stlgordon@gmail.com
Insights
A single dose of intramuscular dexamethasone is as effective as a 5-day oral prednisolone course for treating moderate childhood asthma exacerbations in emergency department patients. Both treatments showed similar clinical outcomes and readmission rates.
Area of Science:
- Pediatric Emergency Medicine
- Pulmonology
- Pharmacology
Background:
- Asthma exacerbations are common in young children.
- Corticosteroids are the mainstay of treatment.
- Optimal corticosteroid regimen for emergency department (ED) discharge remains debated.
Purpose of the Study:
- To compare the clinical efficacy of single-dose intramuscular (IM) dexamethasone phosphate versus a 5-day course of oral prednisolone.
- To evaluate treatment effectiveness for moderate asthma exacerbations in children discharged from the ED.
Main Methods:
- Prospective, randomized trial involving children aged 18 months to 7 years with moderate asthma exacerbations.
- Randomization to either single-dose IM dexamethasone or 5-day oral prednisolone.
- Primary outcome: change in asthma score at 4-day follow-up for ED-discharged patients.
Main Results:
- No significant difference in the mean change of asthma scores between dexamethasone (3.6) and prednisolone (3.4) groups at 4-day follow-up.
- Similar rates of hospital admission before 2-week follow-up: 5.9% for dexamethasone vs. 4.1% for prednisolone.
Conclusions:
- Single-dose IM dexamethasone is clinically comparable to a 5-day oral prednisolone course for moderate pediatric asthma exacerbations.
- This finding supports the use of a simpler, single-dose regimen for discharged patients.
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.
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