Is Oral Dexamethasone Safe and Effective For Treating Asthma Exacerbations In Pediatric Patients?

OBJECTIVE: The objective of this selective evidence based medicine review is to determine whether or not a one or two dose regimen of dexamethasone (DEX) is a safe and effective treatment for asthma exacerbations in the pediatric population. STUDY DESIGN: Review of three English language, primary randomized controlled trials (RCT) published from 2001-2008. DATA SOURCES: Three RCTs examining the efficacy of DEX either in a single dose or one dose for two days, compared to a traditional five day regimen of prednisone (PRED). OUTCOMES MEASURED: The studies examined the number of relapses within 10 days of using DEX or PRED, the number of subjects with unscheduled returns to the emergency department (ED) or other health care facility within 5 days, and episodes of emesis after administration of drug in the ED and at home within 5 days. RESULTS: These studies concluded that both a single dose and two doses of DEX was no less effective than a five day regimen of PRED, specifically in regards to relapse rates and time to recovery. DEX did not lead to a higher rate of emesis than PRED either in the ED or within five days of initial treatment. CONCLUSIONS: DEX is equally effective to PRED in the treatment of acute asthma exacerbations in pediatric patients, and does not lead to a greater rate of emesis within 5 days of treatment. Because DEX can be administered in a single dose or in a two day regimen, instead of the five day regimen required of PRED, patients may be more satisfied and have a higher compliance rate by using DEX.