Adoption of Dexamethasone for Asthma Exacerbations

Previous work has demonstrated that dexamethasone has similar efficacy to prednisolone/prednisone for the management of asthma exacerbations. We sought to evaluate trends in the use of dexamethasone for asthma among children discharged from the emergency department (ED) and to evaluate the association of corticosteroid choice with return visits and hospitalizations.

We conducted a retrospective cross-sectional analysis of 28 hospitals between 2010 and 2024, including children (<18 years) discharged from the ED with an acute asthma exacerbation who received either dexamethasone or prednisolone/prednisone. We identified trends in corticosteroid selection using breakpoint analysis and evaluated the association of corticosteroid selection with any ED return visit and return visits leading to hospitalization within 7 days.

We included 491 576 encounters (median age of 6.2 years [IQR 4.0-9.8]; 62.4% for boys). Of these, 216 874 (44.1%) received prednisolone/prednisone and 274 702 (55.9%) received dexamethasone. There was an increase in use of dexamethasone (91.1% given prednisolone/prednisone in 2010; 95.3% given dexamethasone by 2024). We identified breakpoints in September 2013 and December 2015. During the 27-month period between these points, adoption of dexamethasone increased by 0.7% per month, (95% CI 0.6-0.9%). Dexamethasone was associated with a higher adjusted odds of return visit (1.07, 95% CI 1.03-1.11) and a lower adjusted odds of hospitalization within 7 days relative to prednisolone/prednisone (0.90, 95% CI 0.84-0.97).

We identified a transition toward dexamethasone use for children with asthma discharged from pediatric EDs. This was particularly pronounced between 2013 and 2015, approximately 15 years after the first dexamethasone trials were published.