PURPOSE OF THE STUDY.
The goal of this meta-analysis was to determine whether intramuscular or oral dexamethasone is equivalent or superior to a 5-day course of prednisone or prednisolone for acute exacerbations of asthma.
Children ≤18 years of age presenting to the emergency department (ED) with acute exacerbations of asthma requiring systemic steroids were included in the study.
The authors performed a meta-analysis of 6 randomized controlled trials of acute asthma exacerbations in children presenting to the ED. Treatment with dexamethasone was compared with prednisone/prednisolone treatment for the primary outcome of return visits or readmissions to the hospital.
The authors report similar relative risks (RRs) of relapse at all time points between the 2 groups: 5 days (RR: 0.90 [95% confidence interval (CI): 0.46–1.78]), 10 to 14 days (RR: 1.14 [95% CI: 0.77–1.67]), and 30 days (RR: 1.20 [95% CI: 0.03–56.93]). Dexamethasone was associated with a lower incidence of emesis in either the ED (RR: 0.29 [95% CI: 0.12–0.69]) or home (RR: 0.32 [95% CI: 0.14–0.74]).
The authors recommend that clinicians consider single or 2-dose regimens of dexamethasone as a robust alternative to 5 days of prednisone/prednisolone.
The authors demonstrate by meta-analysis that dexamethasone and prednisone/prednisolone are equally effective therapy regarding prevention of revisits to the clinic, ED, or for hospitalization, but adherence is likely better with the shorter course and is better tolerated. The studies are not sufficient in statistical power to determine whether intramuscular or oral dexamethasone are equivalent. Finally, the generalizability of these conclusions to other health care settings outside of the ED is a subject for future studies.
- Copyright © 2014 by the American Academy of Pediatrics