Nebulized dexamethasone versus oral prednisone in the emergency treatment of asthmatic children.
OBJECTIVE
To compare nebulized dexamethasone with oral prednisone in the treatment of children with asthma.


METHODS
A randomized, double-blind, double-placebo study.


METHODS
An urban pediatric emergency department.


METHODS
Patients aged 1 to 17 years with acute asthma.


METHODS
Patients with moderate asthma exacerbation received frequent aerosolized albuterol and either 1.5 mg/kg of nebulized dexamethasone or 2 mg/kg of oral prednisone.


RESULTS
A total of 111 children was evaluated; 21% of those treated with dexamethasone required hospitalization, compared with 31% of those treated with prednisone (P = .26). A significantly greater proportion of dexamethasone-treated children were discharged home within 2 hours (23% versus 7%, P = .02). In the dexamethasone group, 8% who received the drug by mouthpiece were hospitalized compared with 33% who received it by face mask (P = .06). Fewer children treated with dexamethasone vomited (0% versus 15%, P = .001) and fewer relapsed within 48 hours of ED discharge (0% versus 16%, P = .008).


CONCLUSIONS
Nebulized dexamethasone was as effective as oral prednisone in the ED treatment of moderately ill children with acute asthma and was associated with more rapid clinical improvement, more reliable drug delivery, and fewer relapses.
Scarfone
R J
RJ
Department of Pediatrics, Temple University School of Medicine, St Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.
Loiselle
J M
JM
Wiley
J F
JF
Decker
J M
JM
Henretig
F M
FM
Joffe
M D
MD
D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004630:Emergencies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009330:Nebulizers and Vaporizers; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced
D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D011241:Prednisone