title: A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department.
abstract: In acute exacerbations of asthma in children, corticosteroids reduce relapses, subsequent hospital admission, and the need for ß2-agonist bronchodilators. Prednisolone is the most commonly used corticosteroid, but prolonged treatment course, vomiting, and a bitter taste may reduce patient compliance. Dexamethasone has a longer half-life and has been used safely in other acute pediatric conditions. We examine whether a single dose of oral dexamethasone is noninferior to prednisolone in the emergency department (ED) treatment of asthma exacerbations in children, as measured by the Pediatric Respiratory Assessment Measure (PRAM) at day 4.
  
  
  
  We conducted a randomized, open-label, noninferiority trial comparing oral dexamethasone (single dose of 0.3 mg/kg) with prednisolone (1 mg/kg per day for 3 days) in patients aged 2 to 16 years and with a known diagnosis of asthma or at least 1 previous episode of ß2-agonist-responsive wheeze who presented to a tertiary pediatric ED. The primary outcome measure was the mean PRAM score (range of 0 to 12 points) performed on day 4. Secondary outcome measures included requirement for further steroids, vomiting of study medication, hospital admission, and unscheduled return visits to a health care practitioner within 14 days.
  
  
  
  There were 245 enrollments involving 226 patients. There was no difference in mean PRAM scores at day 4 between the dexamethasone and prednisolone groups (0.91 versus 0.91; absolute difference 0.005; 95% CI -0.35 to 0.34). Fourteen patients vomited at least 1 dose of prednisolone compared with no patients in the dexamethasone group. Sixteen children (13.1%) in the dexamethasone group received further systemic steroids within 14 days after trial enrollment compared with 5 (4.2%) in the prednisolone group (absolute difference 8.9%; 95% CI 1.9% to 16.0%). There was no significant difference between the groups in hospital admission rates or the number of unscheduled return visits to a health care practitioner.
  
  
  
  In children with acute exacerbations of asthma, a single dose of oral dexamethasone (0.3 mg/kg) is noninferior to a 3-day course of oral prednisolone (1 mg/kg per day) as measured by the mean PRAM score on day 4.
authors.affiliation: Paediatric Emergency Research Unit, National Children's Research Centre, Dublin 12, Ireland; Department of Emergency Medicine, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
authors.forename: John J
authors.initials: JJ
authors.lastname: Cronin
authors.affiliation: Paediatric Emergency Research Unit, National Children's Research Centre, Dublin 12, Ireland; Department of Emergency Medicine, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
authors.forename: Siobhan
authors.initials: S
authors.lastname: McCoy
authors.affiliation: Department of Emergency Medicine, St James's Hospital, Dublin 8, Ireland.
authors.forename: Una
authors.initials: U
authors.lastname: Kennedy
authors.affiliation: Paediatric Emergency Research Unit, National Children's Research Centre, Dublin 12, Ireland.
authors.forename: Sinéad Nic
authors.initials: SN
authors.lastname: An Fhailí
authors.affiliation: Emergency Care Research Unit, Division of Population Health Sciences, Royal College of Surgeons, Dublin 2, Ireland.
authors.forename: Abel
authors.initials: A
authors.lastname: Wakai
authors.affiliation: Paediatric Emergency Research Unit, National Children's Research Centre, Dublin 12, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Hayden
authors.affiliation: StatisticaMedica Ltd., Dublin 18, Ireland.
authors.forename: Gloria
authors.initials: G
authors.lastname: Crispino
authors.affiliation: Paediatric Emergency Research Unit, National Children's Research Centre, Dublin 12, Ireland; Department of Emergency Medicine, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland; Department of Paediatrics, University College Dublin, Belfield, Dublin 4, Ireland.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Barrett
authors.affiliation: Paediatric Emergency Research Unit, National Children's Research Centre, Dublin 12, Ireland; Department of Emergency Medicine, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
authors.forename: Sean
authors.initials: S
authors.lastname: Walsh
authors.affiliation: Paediatric Emergency Research Unit, National Children's Research Centre, Dublin 12, Ireland; Department of Emergency Medicine, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland; Department of Paediatrics, University College Dublin, Belfield, Dublin 4, Ireland; School of Medicine, University College Cork, Cork, Ireland. Electronic address: ronanosullivan@ucc.ie.
authors.forename: Ronan
authors.initials: R
authors.lastname: O'Sullivan
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D002673:Child, Hospitalized; D002675:Child, Preschool; D019091:Critical Pathways; D003907:Dexamethasone / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D011239:Prednisolone / Q000008:administration & dosage*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D011239:Prednisolone