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American Academy of Pediatrics
Review Article

Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis

Grant E. Keeney, Matthew P. Gray, Andrea K. Morrison, Michael N. Levas, Elizabeth A. Kessler, Garick D. Hill, Marc H. Gorelick and Jeffrey L. Jackson
Pediatrics March 2014, 133 (3) 493-499; DOI: https://doi.org/10.1542/peds.2013-2273
Grant E. Keeney
Departments of aPediatrics, and
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Matthew P. Gray
Departments of aPediatrics, and
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Andrea K. Morrison
Departments of aPediatrics, and
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Michael N. Levas
Departments of aPediatrics, and
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Elizabeth A. Kessler
Departments of aPediatrics, and
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Garick D. Hill
Departments of aPediatrics, and
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Marc H. Gorelick
Departments of aPediatrics, and
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Jeffrey L. Jackson
bGeneral Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; and
cZablocki VAMC, Milwaukee, Wisconsin
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Abstract

BACKGROUND AND OBJECTIVE: Dexamethasone has been proposed as an equivalent therapy to prednisone/prednisolone for acute asthma exacerbations in pediatric patients. Although multiple small trials exist, clear consensus data are lacking. This systematic review and meta-analysis aimed to determine whether intramuscular or oral dexamethasone is equivalent or superior to a 5-day course of oral prednisone or prednisolone. The primary outcome of interest was return visits or hospital readmissions.

METHODS: A search of PubMed (Medline) through October 19, 2013, by using the keywords dexamethasone or decadron and asthma or status asthmaticus identified potential studies. Six randomized controlled trials in the emergency department of children ≤18 years of age comparing dexamethasone with prednisone/prednisolone for the treatment of acute asthma exacerbations were included. Data were abstracted by 4 authors and verified by a second author. Two reviewers evaluated study quality independently and interrater agreement was assessed.

RESULTS: There was no difference in relative risk (RR) of relapse between the 2 groups at any time point (5 days RR 0.90, 95% confidence interval [CI] 0.46–1.78, Q = 1.86, df = 3, I2 = 0.0%, 10–14 days RR 1.14, 95% CI 0.77–1.67, Q = 0.84, df = 2, I2 = 0.0%, or 30 days RR 1.20, 95% CI 0.03–56.93). Patients who received dexamethasone were less likely to experience vomiting in either the emergency department (RR 0.29, 95% CI 0.12–0.69, Q = 3.78, df = 3, I2 = 20.7%) or at home (RR 0.32, 95% CI 0.14–0.74, Q = 2.09, df = 2, I2 = 4.2%).

CONCLUSIONS: Practitioners should consider single or 2-dose regimens of dexamethasone as a viable alternative to a 5-day course of prednisone/prednisolone.

  • dexamethasone
  • prednisone
  • prednisolone
  • asthma
  • status asthmaticus
  • Accepted December 4, 2013.
  • Copyright © 2014 by the American Academy of Pediatrics

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Pediatrics
Vol. 133, Issue 3
1 Mar 2014
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Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis
Grant E. Keeney, Matthew P. Gray, Andrea K. Morrison, Michael N. Levas, Elizabeth A. Kessler, Garick D. Hill, Marc H. Gorelick, Jeffrey L. Jackson
Pediatrics Mar 2014, 133 (3) 493-499; DOI: 10.1542/peds.2013-2273

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Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis
Grant E. Keeney, Matthew P. Gray, Andrea K. Morrison, Michael N. Levas, Elizabeth A. Kessler, Garick D. Hill, Marc H. Gorelick, Jeffrey L. Jackson
Pediatrics Mar 2014, 133 (3) 493-499; DOI: 10.1542/peds.2013-2273
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