BACKGROUND AND 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.
BACKGROUND AND 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.
Entities:
Keywords:
asthma; dexamethasone; prednisolone; prednisone; status asthmaticus
Authors: N G Papadopoulos; H Arakawa; K-H Carlsen; A Custovic; J Gern; R Lemanske; P Le Souef; M Mäkelä; G Roberts; G Wong; H Zar; C A Akdis; L B Bacharier; E Baraldi; H P van Bever; J de Blic; A Boner; W Burks; T B Casale; J A Castro-Rodriguez; Y Z Chen; Y M El-Gamal; M L Everard; T Frischer; M Geller; J Gereda; D Y Goh; T W Guilbert; G Hedlin; P W Heymann; S J Hong; E M Hossny; J L Huang; D J Jackson; J C de Jongste; O Kalayci; N Aït-Khaled; S Kling; P Kuna; S Lau; D K Ledford; S I Lee; A H Liu; R F Lockey; K Lødrup-Carlsen; J Lötvall; A Morikawa; A Nieto; H Paramesh; R Pawankar; P Pohunek; J Pongracic; D Price; C Robertson; N Rosario; L J Rossenwasser; P D Sly; R Stein; S Stick; S Szefler; L M Taussig; E Valovirta; P Vichyanond; D Wallace; E Weinberg; G Wennergren; J Wildhaber; R S Zeiger Journal: Allergy Date: 2012-06-15 Impact factor: 13.146
Authors: Jillian M Cotter; Amy Tyler; Jennifer Reese; Sonja Ziniel; Monica J Federico; William C Anderson Iii; Oren Kupfer; Stanley J Szefler; Gwendolyn Kerby; Heather E Hoch Journal: J Asthma Date: 2019-06-12 Impact factor: 2.515
Authors: Francine M Ducharme; Sharon D Dell; Dhenduka Radhakrishnan; Roland M Grad; Wade T A Watson; Connie L Yang; Mitchell Zelman Journal: Can Respir J Date: 2015-04-20 Impact factor: 2.409
Authors: Francine M Ducharme; Sharon D Dell; Dhenuka Radhakrishnan; Roland M Grad; Wade Ta Watson; Connie L Yang; Mitchell Zelman Journal: Paediatr Child Health Date: 2015-10 Impact factor: 2.253