Single-Dose Oral Dexamethasone in the Emergency Management of Children With Exacerbations of Mild to Moderate Asthma

Altamimi, Saleh; Robertson, Glenn; Jastaniah, Wasil; Davey, Allyson L.; Dehghani, N.; Chen, Ruth; Leung, Karen Ka Yan; Colbourne, Margaret

doi:10.1097/01.pec.0000248683.09895.08

Cited by 80 publications

(85 citation statements)

References 19 publications

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“…Application of inclusion and exclusion criteria resulted in 6 studies that were included in our analysis (Fig 1). [11][12][13][14][15][16] All of the included studies were performed in EDs and had a mean of 171 participants (range 15-272). All studies but one (Gordon et al 12 ) defined relapse as an unplanned clinic visit, return ED visit, or an unplanned hospital admission related to their initial asthma exacerbation.…”

Section: Resultsmentioning

confidence: 99%

“…All studies but one (Gordon et al 12 ) defined relapse as an unplanned clinic visit, return ED visit, or an unplanned hospital admission related to their initial asthma exacerbation. Dexamethasone was given as a single IM dose in 3 studies, 12,14,15 as a single oral dose in 1 study, 11 and as multiple oral doses in 2 studies 13,16 (Table1). Included studies were from the United States (n = 5) and Canada (n = 1).…”

Section: Resultsmentioning

confidence: 99%

“…The 4 studies that reported 5-day follow-up relapse rates all used a single dose of IM or PO dexamethasone. 11,12,14,15 Five days was the most common follow-up duration and is the most clinically relevant period in which to detect treatment failure. This is supported by the fact that 5-day courses of oral corticosteroids have not been shown to be superior to 3-day courses for outpatient management of children with acute exacerbations.…”

Section: Discussionmentioning

confidence: 99%

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Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis

et al. 2014

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BACKGROUND AND OBJECTIVE: Dexamethasone has been proposed as an equivalent therapy to prednisone/prednisolone for acute asthma exacerbations in pediatric patients. Although multiple small trials exist, clear consensus data are lacking. This systematic review and meta-analysis aimed to determine whether intramuscular or oral dexamethasone is equivalent or superior to a 5-day course of oral prednisone or prednisolone. The primary outcome of interest was return visits or hospital readmissions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis

et al. 2014

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“…In patients with mild to moderate exacerbations, a single dose of dexamethasone of 0.6 mg/kg may be similarly effective. 94 Both older and more recent studies have indicated that inhaled corticosteroids are less effective than oral corticosteroids during acute exacerbations in children, 95,96 and systemic corticosteroids should therefore be used for stabilization. 97 …”

Section: Bronchodilatorsmentioning

confidence: 99%

Achieving control of asthma in preschoolers

Kovesi¹,

Schuh²,

Spier³

et al. 2009

Canadian Medical Association Journal

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“…Altamimi et al 32 compared a single dose of PO dexamethasone with 5 days of PO prednisolone in a prospective, randomized, double-blind study. Patients with mild to moderate asthma were randomized to receive either dexamethasone or prednisolone in the ED, then discharged with 5 days of placebo or liquid prednisolone, respectively.…”

Section: Oral Dexamethasonementioning

confidence: 99%

Is Dexamethasone an Effective Alternative to Oral Prednisone in the Treatment of Pediatric Asthma Exacerbations?

Meyer

Riese

Biondi

2014

Hospital Pediatrics

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Background: A short course of systemic corticosteroids is an important therapy in the treatment of pediatric asthma exacerbations. Although a 5-day course of oral prednisone or prednisolone has become the most commonly used regimen, dexamethasone has also been used for a shorter duration (1–2 days) with potential for improvement in compliance and palatability. We reviewed the literature to determine if there is sufficient evidence that dexamethasone can be used as an effective alternative in the treatment of pediatric asthma exacerbations in the inpatient setting. Methods: A Medline search was conducted on the use of dexamethasone in the treatment of asthma exacerbations in children. The studies selected were clinical trials comparing the efficacy of dexamethasone with prednisone. Meta-analysis was performed examining physician revisitation rates and symptomatic return to baseline. Results: Six completed pediatric clinical trials met the inclusion criteria. All of the pediatric trials found that prednisone is not superior to dexamethasone in treating mild to moderate asthma exacerbations. Meta-analysis demonstrated homogeneity between the dexamethasone and prednisone groups when examining symptomatic return to baseline and unplanned physician revisits after the initial emergency department encounter. Some studies found potential additional benefits of dexamethasone, including improved compliance and less vomiting. Conclusions: The current literature suggests that dexamethasone can be used as an effective alternative to prednisone in the treatment of mild to moderate acute asthma exacerbations in children, with the added benefits of improved compliance, palatability, and cost. However, more research is needed to examine the role of dexamethasone in hospitalized children.

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Single-Dose Oral Dexamethasone in the Emergency Management of Children With Exacerbations of Mild to Moderate Asthma

Abstract: A single dose of oral Dex (0.6 mg/kg) is no worse than 5 days of twice-daily prednisolone (1 mg/kg per dose) in the management of children with mild to moderate asthma.

Cited by 80 publications

References 19 publications

Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis

Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis

Achieving control of asthma in preschoolers

Is Dexamethasone an Effective Alternative to Oral Prednisone in the Treatment of Pediatric Asthma Exacerbations?

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