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Published on: November 4, 2010
Outcomes of a dexamethasone-prednisone combination treatment course for status asthmaticus
Shelby Nelipovich1, Sarah H Vepraskas2, Paula Soung2
1Department of Pediatrics, University of Rochester, Golisano Children's Hospital, Rochester, NY, USA.
Insights
For pediatric asthma, combination therapy with dexamethasone and prednisone shows comparable 30-day readmission rates to prednisone alone. Dexamethasone monotherapy also yielded similar outcomes for hospitalized patients.
Area of Science:
- Pediatric Pulmonology
- Emergency Medicine
- Pharmacology
Background:
- Dexamethasone is standard for pediatric status asthmaticus in emergency departments.
- Inpatient decisions involve continuing dexamethasone or switching to prednisone.
- The comparative effectiveness of dexamethasone, prednisone, and combination therapy is unclear.
Purpose of the Study:
- To compare patient characteristics and outcomes of dexamethasone, prednisone, and combination therapy for inpatient asthma management.
- To analyze emergency department (ED) reutilization and hospital readmission rates based on steroid regimens.
Main Methods:
- Retrospective study of 1697 children (2-18 years) hospitalized with asthma-related diagnoses.
- Steroid groups: dexamethasone, prednisone, or combination therapy.
- Statistical analysis included Fisher's exact, Chi-square, Kruskal-Wallis, and multivariable logistic regression.
Main Results:
- Combination therapy (58.0%) was most common, followed by prednisone (35.2%) and dexamethasone (6.8%).
- Combination therapy patients had lower exacerbation severity than prednisone but higher than dexamethasone.
- Dexamethasone and combination therapy were not associated with increased 30-day ED reutilization/readmissions compared to prednisone.
Conclusions:
- Most hospitalized pediatric asthma patients received combination steroid therapy.
- Despite severity differences, combination therapy and dexamethasone monotherapy showed comparable readmission rates to prednisone monotherapy.
- Steroid choice did not significantly impact short-term ED reutilization or hospital readmission rates.
Objectives:
Dexamethasone has become the standard of care for pediatric patients with status asthmaticus in the emergency department (ED) setting. Inpatient providers often must decide between continuing the second dose of dexamethasone or transitioning to prednisone. The effectiveness of receiving dexamethasone followed by prednisone (combination therapy) compared to only prednisone or dexamethasone remains unclear. This study compares patient characteristics and ED reutilization/hospital readmission outcomes of dexamethasone, prednisone, and combination therapy for inpatient asthma management.
Methods:
A retrospective study was conducted at our tertiary children's hospital of children aged 2 to 18 years hospitalized between March 2016 and December 2018 with a primary discharge diagnosis of asthma, reactive airway disease, or bronchospasm. The differences between steroid groups were compared using Fisher's exact or Chi-square tests for categorical variables, and a Kruskal-Wallis test for continuous variables. A multivariable logistic regression was performed to analyze ED reutilization and hospital readmission rates.
Results:
1697 subjects met inclusion criteria. 115 (6.8%) patients received dexamethasone, 597 (35.2%) received prednisone, and 985 (58.0%) received combination therapy. Patients prescribed combination therapy had a lower exacerbation severity than patients prescribed prednisone, but higher severity than patients prescribed dexamethasone (p < .001, p = .001, respectively). Dexamethasone and combination therapy were not associated with increased 30-day ED reutilization/hospital readmissions compared to prednisone (p > .05).
Conclusions:
In our study, most patients hospitalized for status asthmaticus received combination therapy. Despite the differences in severity between steroid groups, outcomes of combination therapy and dexamethasone monotherapy, as measured by frequency of ED reutilizations/hospital readmissions, are comparable to prednisone monotherapy.
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