Low-dose dexamethasone vs prednisolone for acute asthma attacks in children?

  • Wallace S & al.
  • Arch Dis Child
  • 16 Feb 2021

  • curated by Dawn O'Shea
  • UK Medical News
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A single dose of dexamethasone is non-inferior to three to five days of prednisolone for children presenting acutely with asthma or wheeze, according to an article published in the Archives of Disease in Childhood.

The authors present the case of a five-year-old girl who presented to the paediatric emergency department with an asthma attack requiring oral steroids. Following inhaled salbutamol therapy, she spit out or vomited the oral prednisolone despite repeat attempts of administration.

The senior house officer asked about using dexamethasone. However, for her weight the dose of 0.6 mg/kg exceeds the recommended prednisolone equivalent.

A team from West Middlesex Hospital, Imperial College London trust and the University of York Alcuin College searched Medline (from 1946 to 19 May 2020) and Embase (from 1980 to week 20 of 2020) for relevant articles. A total of 30 abstracts and references were reviewed, and three articles were selected - two randomised controlled trials (RCTs) and a quasi-RCT.

The largest of the studies was an open-label trial conducted in Ireland of single dose 0.3 mg/kg dexamethasone compared with three days of oral prednisolone (1 mg/kg/day), which demonstrated non-inferiority in hospital admission rates, length of admission and reattendance.

However, 50 per cent of patients admitted to hospital receiving dexamethasone had a subsequent course of steroids despite their paediatric respiratory assessment measure (PRAM) scores in ED and admission being similar and not requiring higher doses of B2-agonists. The authors say the finding suggests clinician bias rather than clinical requirement for further steroids.

The authors conclude that a single dose of 0.3 mg/kg oral dexamethasone, particularly for younger children, who are less likely to tolerate prednisolone, avoids giving higher doses of systemic corticosteroids which have not been found to be associated with better clinical outcomes.

They add that the more palatable taste of dexamethasone "which for anyone who has attempted to administer an oral medicine to a young child in A&E might be just enough to convince them to give dexamethasone a try locally."