Single-Dose Dexamethasone an Option for Acute Adult Asthma
Am Fam Physician. 2017 Mar 15;95(6):online.
Is a single dose of dexamethasone as effective as five days of prednisone for acute exacerbations of asthma?
A single dose of 12-mg dexamethasone, which has a longer duration of action than prednisone, is almost as effective as five days of 60-mg prednisone for the prevention of relapse in adults with acute asthma treated in an emergency department. It is a reasonable option for treatment in the emergency department, given its fewer adverse effects. In this study, patients who received the single dose also took placebo for four days. Further research is needed to determine whether patients are comfortable with taking just a single dose. (Level of Evidence = 2b)
These investigators enrolled 465 adults younger than 56 years who presented with acute asthma to an emergency department and required at least one treatment with a beta agonist. The patients were randomly assigned, using concealed allocation, to receive treatment with prednisone, 60 mg daily, for five days or a single dose of dexamethasone, 12 mg, followed by four days of placebo. Treatment was started in the emergency department. Of the 465 persons initially enrolled, 376 could be evaluated; 16 were admitted before leaving the emergency department and 73 could not be contacted (more in the dexamethasone group). Over the subsequent two weeks, 12.1% of the dexamethasone group and 9.8% of the prednisone group had a relapse that required additional treatment (difference = 2.3%; 95% confidence interval, −4.1% to 8.6%). This difference did not meet the researchers' threshold for noninferiority of 8%, meaning that treatment with dexamethasone was slightly less effective. The hospitalization rate was low (3%) and did not differ between treatment groups. Adverse effects were more common in the prednisone group.
Study design: Randomized controlled trial (double-blinded)
Funding source: Foundation
Setting: Emergency department
Reference: Rehrer MW, Liu B, Rodriguez M, Lam J, Alter HJ. A randomized controlled noninferiority trial of single dose of oral dexamethasone versus 5 days of oral prednisone in acute adult asthma. Ann Emerg Med. 2016;68(5):608–613.
POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.
For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.
To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.
This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.
A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.
Want to use this article elsewhere? Get Permissions
More in AFP
MOST RECENT ISSUE
Jul 15, 2018
Access the latest issue of American Family Physician