Clinical Question

In children with acute exacerbation of asthma, is a single dose of corticosteroid as effective as three days of treatment?

Bottom Line

In addition to usual beta-agonist treatment, a single dose of oral dexamethasone is as effective as three days of prednisolone (with less vomiting) in decreasing respiratory symptoms without increasing hospitalizations, follow-up visits, and days lost from school. Additional treatment with a steroid was more common in the group receiving the single dose of dexamethasone. (Level of Evidence = 1b)

Synopsis

These Irish investigators enrolled 226 children (for a total of 245 enrollments; some were enrolled twice) between the ages of two and 16 years with an acute exacerbation of asthma. The children were randomized (concealed allocation unknown) to receive a single dose of oral dexamethasone (0.3 mg per kg) or three days of oral prednisolone (1 mg per kg per day) in addition to usual therapy. None of the patients, their parents, or the investigators were masked to treatment assignment, although the outcome assessor was unaware of treatment at the time of evaluation, which was four days after presentation. The Pediatric Respiratory Assessment Measure (PRAM) was used to measure symptoms. It consists of measuring suprasternal and scalene muscle contraction, air entry, wheezing, and oxygen saturation, with a maximum score of 12. After four days, PRAM scores were similar between the two groups (0.91 vs. 0.91). Hospital admission rates were also similar between the two groups, as were days lost from school and parental workdays missed. Return visits were similar between the two groups, although more children receiving the single dose required further steroid treatment within the following two weeks (13% vs. 4%). Vomiting occurred more often with prednisolone.

Study design: Randomized controlled trial (nonblinded)

Funding source: Foundation

Allocation: Uncertain

Setting: Emergency department

Reference: CroninJJMcCoySKennedyUet alA randomized trial of single-dose oral dexamethasone versus multidose prednisolone for acute exacerbations of asthma in children who attend the emergency department. Ann Emerg Med2016;67(5):593–601.e3.