Methylprednisolone, dexamethasone or hydrocortisone for acute severe pediatric asthma: does it matter?

Doymaz, Sule; Ahmed, Youssef; Francois, Densley; Pinto, Rohit; Gist, Ramon E; Steinberg, Miriam; Giambruno, Clara

doi:10.1080/02770903.2020.1870130

Cited by 5 publications

(4 citation statements)

References 23 publications

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“…(1.67 mg/kg/dose every 8 h for 5 days), and dexamethasone (0.6 mg/kg/dose every 6 h for 3 days) for critical asthma. 34 The authors found no detectable differences in continuous albuterol duration, the primary study endpoint, and no observed corticosteroid-related adverse events. This report included a heterogenous sample (young adults and children under 5 years of age), was intended as a pilot, and inadequately powered to detect relationships to offer generalizability.…”

Section: Safety Endpoint Datamentioning

confidence: 87%

“…Although both dexamethasone and methylprednisolone are approved for use in children for inflammatory disorders like asthma, they differ pharmacologically in their elimination half‐life and body distribution 10,11 . Before this report, only one pilot PICU‐specific trial had been conducted by Doymaz et al who randomized 61 children aged 1 through 21 years to receive IV methylprednisolone (0.5 mg/kg/dose every 6 h for 5 days), hydrocortisone (1.67 mg/kg/dose every 8 h for 5 days), and dexamethasone (0.6 mg/kg/dose every 6 h for 3 days) for critical asthma 34 . The authors found no detectable differences in continuous albuterol duration, the primary study endpoint, and no observed corticosteroid‐related adverse events.…”

Section: Discussionmentioning

confidence: 99%

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

Roddy

Sellers

Darville

et al. 2023

Pediatric Pulmonology

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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.

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Section: Safety Endpoint Datamentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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

Roddy

Sellers

Darville

et al. 2023

Pediatric Pulmonology

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“…To date, only one underpowered, single-center pilot randomized controlled trial has been conducted in the PICU setting that was unable to detect differences in duration of continuous nebulized albuterol exposure or LOS for children with critical asthma receiving either intravenous methylprednisolone or dexamethasone. 19 A systematic review of nine adult trials including 344 patients was conducted by Manser and colleagues assessing dosing strategies of intravenous methylprednisolone. 20 They found no differences in dosing intensity as measured by percent forced expiratory volumes in 1 min or adverse drug-related effects.…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone for Pediatric Critical Asthma: A Multicenter Descriptive Study

Sellers

Roddy

Darville

et al. 2022

J Intensive Care Med

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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.

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“…Of note, dexamethasone use has been increasing over the last decade across many children's hospitals and it has been shown that patients who received dexamethasone alone seemed to have reduction in asthma severity indices, length of stay and need for additional adjunctive asthma interventions [26]. Much of the recent literature focuses on ongoing treatment of status asthmaticus in pediatric critical care units where it has been found that dexamethasone was not inferior to methylprednisone or hydrocortisone when comparing steroid's effect on length of time on continuous albuterol while hospitalized [27]. Dosing comparisons of methylprednisone 1 mg/kg/dose q6 h (max of 60 mg) versus dexamethasone 0.25 mg/kg/dose q6 h (max 15 mg) showed no difference in the hospital length of stay, duration of continuous albuterol or additional adjunctive medications [28 ▪▪ ].…”

Section: Asthmamentioning

confidence: 99%

Revisiting dexamethasone use in the pediatric emergency department

Weinstein,

Naber,

Brumme

2024

Current Opinion in Pediatrics

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Purpose of review Dexamethasone is an essential treatment for common pediatric inflammatory, airway, and respiratory conditions. We aim to provide up-to-date recommendations for treatment of anaphylaxis, croup, coronavirus disease, multisystem inflammatory syndrome in children, and asthma with dexamethasone for use in the pediatric emergency department. Recent findings Literature largely continues to support the use of dexamethasone in most of the above conditions, however, recommendations for dosing and duration are evolving. Summary The findings discussed in this review will enable pediatric emergency medicine providers to use dexamethasone effectively as treatment of common pediatric conditions and minimize the occurrence of side-effects caused by gratuitous corticosteroid use.

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Methylprednisolone, dexamethasone or hydrocortisone for acute severe pediatric asthma: does it matter?

Cited by 5 publications

References 23 publications

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

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

Dexamethasone for Pediatric Critical Asthma: A Multicenter Descriptive Study

Revisiting dexamethasone use in the pediatric emergency department

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