Comparative efficacy of oral dexamethasone versus oral prednisone in acute pediatric asthma.
OBJECTIVE
The objective was to determine whether 2 days of oral dexamethasone (DEX) is more effective than 5 days of oral prednisone/prednisolone (PRED) in improving symptoms and preventing relapse in children with acute asthma.


METHODS
This was a prospective randomized trial of children (2 to 18 years old) who presented to the emergency department with acute asthma. PRED 2 mg/kg, maximum 60 mg (odd days) or DEX 0.6 mg/kg, maximum 16 mg (even days) was used. At discharge children in the PRED group were prescribed 4 daily 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 primary 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 vomiting in the emergency department (3% vs 0.3%; P =.008), more parents were noncompliant (4% vs. 0.4%; P =.004), and more children missed > or =2 days of school (19.5% vs. 13.2%; P =.05).


CONCLUSIONS
In children with acute asthma, 2 doses of dexamethasone provide similar efficacy with improved compliance and fewer side effects than 5 doses of prednisone.
Qureshi
F
F
Department of Pediatrics and the Division of Pediatric Emergency Medicine, Children's Hospital of The Kings Daughters and Eastern Virginia Medical School, Norfolk, Virginia 23507, USA.
Zaritsky
A
A
Poirier
M P
MP
D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011241:Prednisone / Q000008:administration & dosage* / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome
D005938:Glucocorticoids; D003907:Dexamethasone; D011241:Prednisone