title: Dexamethasone for acute asthma exacerbations in children: a meta-analysis.
abstract: 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.
authors: Departments of Pediatrics, and.
authors: Grant E
authors: GE
authors: Keeney
authors: Matthew P
authors: MP
authors: Gray
authors: Andrea K
authors: AK
authors: Morrison
authors: Michael N
authors: MN
authors: Levas
authors: Elizabeth A
authors: EA
authors: Kessler
authors: Garick D
authors: GD
authors: Hill
authors: Marc H
authors: MH
authors: Gorelick
authors: Jeffrey L
authors: JL
authors: Jackson
mesh_terms: D000208:Acute Disease; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D002648:Child; D002986:Clinical Trials as Topic / Q000379:methods; D003907:Dexamethasone / Q000627:therapeutic use*; D006801:Humans
chemical_list: D000893:Anti-Inflammatory Agents; D003907:Dexamethasone
keywords: asthma; dexamethasone; prednisolone; prednisone; status asthmaticus