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Randomized Trial of Dexamethasone Versus Prednisone for Children with Acute Asthma Exacerbations
Natalia Paniagua1, Rebeca Lopez1, Natalia Muñoz1
1Pediatric Emergency Department, Cruces University Hospital, BioCruces Health Research Institute. Bilbao, Basque Country, Spain.
Insights
Two doses of dexamethasone proved as effective as a 5-day course of prednisolone/prednisone for pediatric asthma exacerbations, showing similar symptom persistence and quality of life improvements.
Area of Science:
- Pediatric Emergency Medicine
- Pharmacology
- Respiratory Medicine
Background:
- Asthma exacerbations are a common reason for pediatric emergency department visits.
- Corticosteroids like prednisolone/prednisone are standard treatment, but shorter courses are desirable.
Purpose of the Study:
- To compare the efficacy of a 2-dose dexamethasone regimen against a 5-day prednisolone/prednisone course in children with asthma exacerbations.
- To evaluate symptom persistence and quality of life at 7 days post-treatment.
Main Methods:
- A randomized, noninferiority trial involving 590 children (aged 1-14 years) with acute asthma.
- Comparison of 2 doses of dexamethasone (0.6 mg/kg/dose) versus a 5-day course of prednisolone/prednisone (1.5 mg/kg/d, then 1 mg/kg/d).
- Outcomes assessed via telephone interviews at 7 and 15 days, focusing on symptoms, quality of life, and unscheduled healthcare visits.
Main Results:
- No significant differences were observed in symptom persistence (56.6% vs 58.3%) or quality of life scores between the dexamethasone and prednisolone/prednisone groups at day 7.
- Admission rates, unscheduled return visits to the ED, and vomiting incidence were similar between groups.
- Adherence to medication was significantly higher in the dexamethasone group (99.3% vs 96.0%, P < .05).
Conclusions:
- A 2-dose regimen of dexamethasone is a potentially effective alternative to a 5-day course of prednisolone/prednisone for treating pediatric asthma exacerbations.
- The findings suggest that shorter corticosteroid courses may be sufficient for managing acute asthma in children.
- Improved adherence with the dexamethasone regimen could contribute to its overall effectiveness.
Objective:
To determine whether 2 doses of dexamethasone is as effective as 5 days of prednisolone/prednisone therapy in improving symptoms and quality of life of children with asthma exacerbations admitted to the emergency department (ED).
Study Design:
We conducted a randomized, noninferiority trial including patients aged 1-14 years who presented to the ED with acute asthma to compare the efficacy of 2 doses of dexamethasone (0.6 mg/kg/dose, experimental treatment) vs a 5-day course of prednisolone/prednisone (1.5 mg/kg/d, followed by 1 mg/kg/d on days 2-5, conventional treatment). Two follow-up telephone interviews were completed at 7 and 15 days. The primary outcome measures were the percentage of patients with asthma symptoms and quality of life at day 7. Secondary outcomes were unscheduled returns, admissions, adherence, and vomiting.
Results:
During the study period, 710 children who met the inclusion criteria were invited to participate and 590 agreed. Primary outcome data were available in 557 patients. At day 7, experimental and conventional groups did not show differences related to persistence of symptoms (56.6%, 95% CI 50.6-62.6 vs 58.3%, 95% CI 52.3-64.2, respectively), quality of life score (80.0 vs 77.7, not significant [ns]), admission rate (23.9% vs 21.7%, ns), unscheduled ED return visits (4.6% vs 3.3%, ns), and vomiting (2.1% vs 4.4%, ns). Adherence was greater in the dexamethasone group (99.3% vs 96.0%, P < .05).
Conclusion:
Two doses of dexamethasone may be an effective alternative to a 5-day course of prednisone/prednisolone for asthma exacerbations, as measured by persistence of symptoms and quality of life at day 7.
Clinical Trial Registration:
clinicaltrialsregister.eu: 2013-003145-42.
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