Current Practice and Rationale of Prescribing Dexamethasone for Pediatric Patients Hospitalized for Asthma

Dexamethasone use for pediatric asthma exacerbations in the emergency department is supported in literature as a beneficial alternative to prednisone; however, there is limited data in the hospital setting. This study assesses factors that influence pediatric hospital providers' steroid choice for patients hospitalized for status asthmaticus.

A survey was developed to assess factors influencing steroid prescribing practices. It was completed by our institution's pediatric hospitalists and advance practice providers in June 2019 and April 2021. Responses were summarized using descriptive statistics, interrater agreement was analyzed with Cohen's kappa statistic, and bivariate comparisons were analyzed with chi-square tests.

Thirty-six of 39 providers completed the survey in 2019; 31 of 43 completed it in 2021. They reported wide disagreement with the use of dexamethasone in both surveys (2019 vs 2021: 34% vs 55% in favor, 43% vs 35% neutral, 23% vs 9% opposing, P = 0.191). There was a self-reported increase in prescribing frequency of dexamethasone from 2019 to 2021 (P = 0.007). There was moderate agreement with prescribing dexamethasone for patients with poor oral tolerance or medication noncompliance (2019: κ = 0.485, P = 0.002; 2021: κ = 0.281, P = 0.048). There was moderate agreement with prescribing prednisone for patients with higher severity of baseline asthma or current exacerbation (2019: κ = 0.537, P < 0.001; 2021: κ = 0.500, P < 0.001). Length of the dexamethasone course did not influence prescribing practices (P > 0.05).

In our inpatient setting, prednisone is preferred for severe asthma cases, while dexamethasone is preferred for patients with poor oral tolerance or medication noncompliance. The length of the dexamethasone course did not influence providers' steroid choice.