Dexamethasone Treatment Regimen and Clinical Outcomes in Children With Asthma Exacerbations

To detail variation in the number of doses of dexamethasone used to treat children with asthma exacerbations discharged from the emergency department (ED) and to assess whether treatment with 1 dose versus 2 doses was associated with different clinical outcomes. We hypothesized that clinical outcomes would not differ between groups.

We conducted a retrospective cohort study of children aged 2 to 20 years discharged from either of 2 EDs after treatment with dexamethasone for an asthma exacerbation. The primary outcome was an ED revisit, and the secondary outcome was a hospitalization, each measured within 14 days. The primary exposure was prescription of a second dose of dexamethasone at discharge. Propensity score adjustment with inverse probability of treatment weighting was used to mitigate confounding.

Among 2,063 children included, 1,277 (61.9%) were prescribed a second dose of dexamethasone. In the propensity score-weighted cohort, the risk of an ED revisit was 5.2% for children who received 1 dose and 5.7% for children who received 2 doses (risk difference, 0.45%, 95% confidence interval [CI]: -1.4% to 2.3%). The risk of hospitalization was 0.85% in the 1-dose group and 0.83% in the 2-dose group (risk difference 0.02%, 95% CI: -0.93% to 0.89%).

Nearly two-thirds of children with asthma exacerbations were treated with 2 doses of dexamethasone rather than a single dose, even though treatment with 2 doses was not associated with improved outcomes. These results suggest that 1 dose of dexamethasone may be sufficient to treat many children with asthma exacerbations discharged from the ED.