title: Randomized trial of single-dose intramuscular dexamethasone compared with prednisolone for children with acute asthma.
abstract: OBJECTIVE
  To compare the clinical efficacy of single-dose intramuscular (IM) dexamethasone phosphate to a 5-day course of oral prednisolone for the treatment of moderate asthma exacerbations in young children discharged from the emergency department (ED).
  
  
  METHODS
  We performed a prospective, randomized trial in children aged 18 months to less than 7 years with asthma who presented to the ED with a clinical asthma score of 3 to 7 on a 9-point scale. Children were randomized to 1 dose of IM dexamethasone (0.6 mg/kg, maximum 15 mg) or oral prednisolone (2 mg/kg, maximum 50 mg) once daily for 5 days. The primary outcome, measured only for patients discharged from the ED, was change in asthma score from ED presentation to 4-day follow-up examination, as assessed by a physician masked to group assignment. We assessed secondary clinical course outcomes by a structured interview at 4 and 14 days.
  
  
  RESULTS
  Eighty-eight patients were appropriately randomized to dexamethasone and 93 to prednisolone. Group characteristics were similar at baseline. Among those discharged from the ED, 62 (90%) of 69 and 64 (90%) of 74 patients in the dexamethasone and prednisolone groups, respectively, were reassessed at 4 days for the primary outcome. The mean change in total asthma score at 4-day follow-up was 3.6 in the dexamethasone group and 3.4 in the prednisolone group (difference, 0.2; 95% confidence interval, -0.4 to 0.7). Of patients initially discharged, 5.9% of dexamethasone patients and 4.1% of prednisolone patients were admitted before the 2-week follow-up (difference, 1.8%; 95% confidence interval, -5.4% to 9.0%).
  
  
  CONCLUSIONS
  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 exacerbations in young children who are discharged from the ED.
authors.affiliation: Columbia University College of Physicians and Surgeons, The Morgan Stanley Children's Hospital of New York-Presbyterian, New York, NY, USA. stlgordon@gmail.com
authors.forename: Stephen
authors.initials: S
authors.lastname: Gordon
authors.forename: Tameko
authors.initials: T
authors.lastname: Tompkins
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D011239:Prednisolone / Q000008:administration & dosage*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D011239:Prednisolone