Objective: The objective was to determine whether 2 days of oral dexamethas
one (DEX) is more effective than 5 days of oral prednisone/prednisolone (PR
ED) in improving symptoms and preventing relapse in children with acute ast
hma.
Study design: This was a prospective randomized trial of children (2 to 18
Sears old) who presented to the emergency department with acute asthma. PRE
D 2 mg/kg, maximum 60 mg (odd days) or DEX 0.6 mg/kg, maximum 16 mg (even d
ays) was used. At discharge children in the PRED group were prescribed 4 da
ily doses (1 mg/kg/d, maximum 60 mg); children in the DEX group received a
prepackaged dose (0.6 mg/kg, maximum 16 mg) to take the next day. The prima
ry outcome was relapse within 10 days.
Results: When DEX was compared with PRED, relapse rates (7.4% of 272 vs 6.9
% of 261), hospitalization rates from the emergency department (11% vs 12%)
or after relapse (20% vs 17%), and symptom persistence at 10 days (22% vs
21%) were similar. In the PRED group more children were excluded for vomiti
ng in the emergency department (3% vs 0.3%; P =.008), more parents were non
compliant (4% vs 0.4%; P =.004), and more children missed greater than or e
qual to2 days of school (19.5% vs 13.2%; P =.05).
Conclusion: In children with acute asthma, 2 doses of dexamethasone provide
similar efficacy with improved compliance and fewer side effects than 5 do
ses of prednisone.