Steroids in Pediatric Asthma

lungAsthma exacerbation is a common complaint seen in the emergency department. The cornerstone of treatment consists of short acting beta agonists (albuterol), respiratory anticholinergics (ipratropium bromide), and steroids. Lets talk about steroid treatment in children with mild to moderate asthma who will likely be discharged to home.

Compliance and completion of outpatient medication is decreased when there is an increase in dosing per day and treatment course. Asthma exacerbation is commonly treated as an outpatient with a 3-10 day course of oral prednisone or prednisolone. Using a longer acting steroid such as dexamethasone can eliminate outpatient dosing and literature supports equal efficacy to the longer dosing regimens.

Randomized trial of single-dose intramuscular dexamethasone compared with prednisolone for children with acute asthma. Pediatric Emergency Care, 2007

Children 8 months – 7 years were randomized to 1 dose IM dexamethasone (0.6mg/kg, max 15mg) or 5 days of oral prednisolone (2mg/kg daily, max 50mg). There were 88 patients in the dexamethasone arm and 93 patients in the prednisolone arm. At a 4 day follow-up there was no statistical difference in outcome. The authors concluded: A single dose of IM dexamethasone showed no clinically meaningful difference in outcomes compared with a 5-day course of oral prednisolone for the treatment of moderate acute asthma exacerbation in young children who are discharged from the ED.

Single-dose oral dexamethasone in the emergency management of children with exacerbations of mild to moderate asthma. Pediatric Emergency Care, 2006

Patients from 2 to 16 years of age with acute mild to moderate asthma exacerbation were randomized to single oral dose of dexamethasone (0.6 mg/kg to a maximum of 18 mg) or oral prednisolone (1 mg/kg per dose to a maximum of 30 mg) twice daily for 5 days. There was no difference in salbutamol therapy in the ED or after discharge in the two groups. The admission rate after discharge was higher in the dexamethasone group (4.9% versus 1.8%), although overall admission rates were similar, 13.4% (dexamethasone) and 14.9% (prednisolone). The authors concluded: A single dose of dexamethasone (0.6 mg/kg) is no worse than 5 days of twice-daily prednisolone (1 mg/kg per dose) in the management of children with mild to moderate asthma.

1) Cross KP, Paul RI, Goldman RD. Single-dose dexamethasone for mild-to-moderate asthma exacerbations: effective, easy, and acceptable. Can Fam Physician. 2011 Oct;57(10):1134-6.
2) Gordon S, Tompkins T, Dayan PS. Randomized trial of single-dose intramuscular dexamethasone compared with prednisolone for children with acute asthma. Pediatr Emerg Care. 2007 Aug;23(8):521-7.
3) Altamimi S, et al. Single-dose oral dexamethasone in the emergency management of children with exacerbations of mild to moderate asthma. Pediatr Emerg Care. 2006 Dec;22(12):786-93.

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