Dexamethasone for Acute Asthma Exacerbations in Children: Meta-Analysis

Background and Objective:

  • Is intramuscular or oral dexamethasone equivalent or superior to 5-day course of oral prednisone or prednisolone in acute asthma exacerbations
    • Advantages of: Shorter course of treatment, Compliance, Less vomiting

Methods:

  • Meta-analysis with six randomized controlled trials in emergency departments in children <18years old
  • Admitted patients were excluded
  • Data included: Age in months, Gender, Ethnicity, Asthma severity score, Treatment characteristics, Number of albuterol treatments, Adverse effects (vomiting), Hospitalization during initial ED visit, Asthma score at ED discharge, Subjective improvement, Relapse rate

Results:

  • 6 studies were included
    • Dexamethasone single IM dose: 3 studies
    • Dexamethasone single oral dose: 1 study
    • Dexamethasone multiple oral doses: 2 studies
  • Relapse were considered: Unplanned clinic visit, Return ED visit, Unplanned hospital admission

Conclusion:

  • Failed to demonstrate a statistically significant difference between the two therapies for the primary outcome of relapse rate to clinic, ED, or hospitalization, suggesting that the two therapies are equivalent
    • No difference in number of albuterol treatments received, post-treatment asthma severity score, hospitalization, relapse rate by five days
  • No difference in relapse rate regardless of route of dexamethasone (oral or IM) compared to prednisone/prednisolone
  • Dexamethasone was associated with less vomiting

Limitations:

  • One study was 80% Hispanic population
  • Mostly boys 63.5% however comparing the treatment groups there was no differences at baseline in portion of boys
  • Unable to address whether
    • IM or PO dexamethasone are equally effective
    • Single oral dexamethasone is equivalent to multiple doses
    • There are differences in efficacy and palatability between different formulations of oral prednisone/prednisolone

Recommendation:

  • Emergency medicine physicians should consider single or two-dose dexamethasone regimens over 5 day prednisone/prednisolone regimens for the treatment of acute asthma exacerbations

Reference:

http://www.ncbi.nlm.nih.gov/pubmed/24515516

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