Dexamethasone Versus Prednisone in Children Hospitalized for Acute Asthma Exacerbations

Hemani, Sunita; Glover, Brianna; Ball, Samantha; Rechler, Willi; Wetzel, Martha; Hames, Nicole; Jenkins, Elan; Lantis, Patricia; Fitzpatrick, Anne M.; Varghese, Susan

doi:10.1542/hpeds.2020-004788

Cited by 9 publications

(14 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…13,21–25 Studies comparing dexamethasone versus alternative systemic corticosteroids for pediatrics are largely observational, limited to the emergency department setting, and focused on relapse rates or acute asthma severity clinical scores as primary endpoints. 12,14,15,26–29…”

Section: Discussionmentioning

confidence: 99%

“…Observational comparative studies have reported two daily doses of dexamethasone are as equivalent to a 5-day course of prednisone or methylprednisolone. 12,16,29 In the emergency department setting this may improve discharge medication compliance. 35 A shorter corticosteroid regimen may diminish pharmacologic-related hospital charges.…”

Section: Discussionmentioning

confidence: 99%

“…13,[21][22][23][24][25] Studies comparing dexamethasone versus alternative systemic corticosteroids for pediatrics are largely observational, limited to the emergency department setting, and focused on relapse rates or acute asthma severity clinical scores as primary endpoints. 12,14,15,[26][27][28][29] Glucocorticoids are essential to the management of acute asthma exacerbation. Mechanistically, they act by activating genomic and nongenomic pathways that reduce inflammation, airway edema, and bronchoconstriction.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Mild exacerbations are managed with enteral dosing of prednisone/prednisolone and more severe disease with intravenous formulations such as methylprednisolone. 11,12 Recently, dexamethasone has been described as a promising alternative given its long half-life (36-72 h) and potent glucocorticoid activity. 13 Observational and meta-analyses data suggest initial treatment with dexamethasone in the emergency department may reduce subsequent inpatient length of stay (LOS), 12 relapse rates, 14 and gastrointestinal side effects as compared to prednisone.…”

Section: Introductionmentioning

confidence: 99%

“…11,12 Recently, dexamethasone has been described as a promising alternative given its long half-life (36-72 h) and potent glucocorticoid activity. 13 Observational and meta-analyses data suggest initial treatment with dexamethasone in the emergency department may reduce subsequent inpatient length of stay (LOS), 12 relapse rates, 14 and gastrointestinal side effects as compared to prednisone. 15 Among cases requiring general pediatric ward admission, those receiving oral methylprednisolone as compared to prednisone experienced reduced direct costs and hospital LOS.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Dexamethasone for Pediatric Critical Asthma: A Multicenter Descriptive Study

Sellers

Roddy

Darville

et al. 2022

J Intensive Care Med

View full text Add to dashboard Cite

Background Systemic corticosteroids are vital to critical asthma management. While intravenous methylprednisolone is routinely used in the pediatric intensive care unit (PICU) setting, recent data supports dexamethasone as an alternative. Using the Pediatric Health Information System (PHIS) registry, we assessed trends and variation in corticosteroid prescribing among children hospitalized for critical asthma. Methods We performed a multicenter retrospective cohort study using PHIS data among children 3-17 years of age admitted for critical asthma from 2011 through 2019. Primary outcomes were corticosteroid prescribing rates by year and participating sites. Exploratory outcomes were corticosteroid-related adverse effects, rates of adjunctive pharmaceutical and respiratory interventions, mortality and length of stay. Results Of the 49 children's hospitals assessed, 26 907 encounters were included for study. Mean dexamethasone exposure rates were 18.1 ± 2.4% where 2.4 ± 1.2% represented dexamethasone-alone prescribing. Dexamethasone alone prescribing exhibited a linear trend (annual increase of 0.5 ± 0.1% annually R2 = 0.845) without correlation to cumulative site critical asthma admission rates. Compared to encounters prescribed solely methylprednisolone or a combination of dexamethasone and methylprednisolone, subjects provided dexamethasone alone had reduced asthma severity indices, length of stay, and exposure rates to adjunctive asthma interventions. Adverse events were rare and the dexamethasone-alone group less frequently experienced gastritis and hyperglycemia. Conclusions In this multicenter retrospective study from 49 children's hospitals, dexamethasone prescribing rates appear increasing for pediatric critical asthma. Observed variability in corticosteroid prescribing implies a continued need for controlled prospective comparative analyses to define ideal corticosteroid regimens for pediatric critical asthma.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Dexamethasone for Pediatric Critical Asthma: A Multicenter Descriptive Study

Sellers

Roddy

Darville

et al. 2022

J Intensive Care Med

View full text Add to dashboard Cite

show abstract

Dexamethasone versus methylprednisolone for critical asthma: A single center, open‐label, parallel‐group clinical trial

Roddy

Sellers

Darville

et al. 2023

Pediatric Pulmonology

View full text Add to dashboard Cite

Background: Evidence for the use of dexamethasone for pediatric critical asthma is limited. We sought to compare the clinical efficacy and safety of dexamethasone versus methylprednisolone among children hospitalized in the pediatric intensive care unit (PICU) for critical asthma. Methods: A prospective, single center, open-label, two-arm, parallel-group, nonrandomized trial among children ages 5−17 years hospitalized within the PICU from April 2019 to December 2021 for critical asthma consented to receive methylprednisolone (standard care) or dexamethasone (intervention) at a 2:1 allocation ratio, respectively. The intervention arm received intravenous dexamethasone 0.25 mg/kg/dose (max: 15 mg/dose) every 6 h for 48 h and the standard care arm intravenous methylprednisolone 1 mg/kg/dose every 6 h (max dose: 60 mg/ dose) for 5 days. Study endpoints were clinical efficacy (i.e., length of stay [LOS], continuous albuterol duration, and a composite of adjunctive asthma interventions)and safety (i.e., corticosteroid-related adverse events).Results: Ninety-two participants were analyzed of whom 31 were allocated to the intervention arm and 61 the standard care arm. No differences in demographics, clinical characteristics, or acute/chronic asthma severity indices were observed. Regarding efficacy and safety endpoints, no differences in hospital LOS, continuous albuterol duration, adjunctive asthma intervention rates, or corticosteroid-related adverse events were noted. Compared to the intervention arm, participants in the standard care arm more frequently were prescribed corticosteroids at discharge (72% vs. 13%, p < 0.001).Conclusions: Among children hospitalized for critical asthma, dexamethasone appears safe and warrants further investigation to fully assess clinical efficacy and potential advantages over commonly applied agents such as methylprednisolone.

show abstract