Medical Minute: Dexamethasone for Asthma Exacerbations

Leave a comment

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

Reference: 
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
Reference: 
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.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: