Medical Minute: Dexamethasone for Asthma Exacerbations

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November 26, 2014 by dailybolusoflr

By: Marrissa Baker, MD
  • Dexamethasone has a longer half-life (36-54 hrs average and up to 72 hrs) than prednisone/prednisolone (8-36hrs) which may lend itself to needing fewer doses and increased compliance
  • In children, there may be less vomiting with dexamethasone possibly related to its superior taste

Is IM or PO dexamethasone equivalent or superior to a 5 day course of PO prednisone/prednisolone?
In Children

Keeney G, Gray M, Morrison A, et al. Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis, Pediatrics March 2014, pp493-499.
  • Meta-analysis that analyzed 6 RCTs from 1997-2008
  • All studies compared dexamethasone with prednisone or prednisolone in ED setting in children ≤ 18 years old that were discharged
  • Dexamethasone was given as a single IM dose (0.3-1.7mg/kg) in 3 studies, as a single PO dose (0.6mg/kg) in 1 study, and as multiple PO doses (0.6mg/kg once daily) in 2 studies

  • Primary outcome was unscheduled return visits to clinic, ED, or hospital admission
  • Secondary outcomes included vomiting in the ED and at home 

  • There was no difference in relapse rate between the two groups at any time point (5, 10-14, and 30 days)
  • Patients who received dexamethasone were less likely to experience vomiting in both the ED and at home

Unable to determine if IM or PO dexamethasone are equally effective, whether a single PO dexamethasone dose is equivalent to multiple doses, or whether there are differences in efficacy and palatability between different formulations of PO dexamethasone
In adults
Kravitz J, et al. Two days of dexamethasone versus 5 days of prednisone in the treatment of acute asthma: a randomized controlled trial. Ann Emerg Med. 2011 Aug;58(2):200-4. doi: 10.1016/j.annemergmed.2011.01.004. Epub 2011 Feb 18.
  • RCT comparing two days of PO dexamethasone (16mg) to 5 days of PO prednisone (50mg)
  • More patients in the dexamethasone group reported a return to normal activity within 3 days compared to prednisone group (90% vs. 80%, P=0.049) and relapse was similar between groups (13% vs. 11%, P=0.67)

Bottom line:

  • Dexamethasone versus prednisone has been more extensively studied in pediatrics. 
  • Consider giving peds patients one dose of dexamethasone in the ED and sending the patient home with one additional dose. 
  • Although it has not been studied as much in adults, dexamethasone may be a medication to consider in certain patients, especially if you are concerned about compliance.

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