NEBULIZED DEXAMETHASONE VERSUS ORAL PREDNISONE IN THE EMERGENCY TREATMENT OF ASTHMATIC-CHILDREN

Study objective: To compare nebulized dexamethasone with oral predniso ne in the treatment of children with asthma. Design: A randomized, dou ble-blind, double-placebo study. Setting: An urban pediatric emergency department. Participants: Patients aged 1 to 17 years with acute asth ma. Interventions: Patients with moderate asthma exacerbation received frequent aerosolized albuterol and either 1.5 mg/kg of nebulized dexa methasone or 2 mg/kg of oral prednisone. Results: A total of 111 child ren was evaluated; 21% of those treated with dexamethasone required ho spitalization, compared with 31% of those treated with prednisone (P=. 26). A significantly greater proportion of dexamethasone-treated child ren were discharged home within 2 hours (23% versus 7%, P=.02). In the dexamethasone group, 8% who received the drug by mouthpiece were hosp italized compared with 33% who received it by face mask (P=.06). Fewer children treated with dexamethasone Vomited (0% versus 15%, P=.001) a nd fewer relapsed within 48 hours of ED discharge (0% Versus 15%, P=.0 08). Conclusion: Nebulized dexamethasone was as effective as oral pred nisone in the ED treatment of moderately ill children with acute asthm a and was associated with more rapid clinical improvement, more reliab le drug delivery, and fewer relapses.