Oral Dexamethasone to Control Wheezing in Children at an Outpatient Clinic

Area of Science:

• Pediatrics
• Pulmonology
• Pharmacoeconomics

Background:

• Asthma is a prevalent chronic childhood disease leading to frequent emergency department (ED) visits and high healthcare costs.
• A significant proportion of pediatric asthma ED visits are for non-emergent conditions potentially manageable in outpatient settings.
• Previous research suggests comparable outcomes between 2-day dexamethasone and 5-day prednisone courses for asthma in ED and hospital settings.

Purpose of the Study:

• To evaluate the clinical effectiveness and cost-efficiency of a 2-day oral dexamethasone regimen versus a 5-day prednisone regimen for acute pediatric asthma exacerbations treated in an ambulatory medical home.
• To compare hospital admission rates, subsequent ED visits, and symptom follow-up between the two treatment groups.
• To analyze the cost differences between dexamethasone and prednisolone treatments and compare primary care visit costs versus ED visit costs.

Main Methods:

• A retrospective chart review was conducted on pediatric patients treated for acute asthma exacerbations.
• Patients received either a 2-day course of dexamethasone (n=23) or a 5-day course of prednisone (n=40) as an in-house corticosteroid treatment.
• Outcomes assessed included hospital admissions, ED revisits, and symptom follow-up, with statistical analysis performed (P > .05).

Main Results:

• No significant differences were observed in hospital admission rates, subsequent ED visits, or symptom follow-up between the dexamethasone and prednisone groups (P > .05).
• The cost of a 2-day dexamethasone course was substantially lower (US$1.28) compared to a 5-day prednisone course (US$16.20).
• Asthma exacerbation office visits averaged US$79.89, significantly less than the US$3113.28 average for ED visits.

Conclusions:

• A 2-day course of oral dexamethasone is a clinically viable and cost-effective alternative for treating acute pediatric asthma exacerbations in primary care settings.
• Implementing dexamethasone in ambulatory care can reduce healthcare expenditures associated with asthma management.
• This approach supports shifting asthma care from emergency departments to more economical outpatient medical homes.