Two regimens of dexamethasone versus prednisolone for acute exacerbations in asthmatic Egyptian children

Abstract

IntroductionAsthma is one of the most prevalent chronic respiratory diseases, which often leads to an emergency department visit. Prednisolone is the most commonly used corticosteroid in treatment of asthma exacerbation. Oral dexamethasone demonstrates bioavailability similar to that of oral prednisolone but has a longer half-life.ObjectiveTo evaluate in adouble-blind,randomised clinical trial the efficacy of different doses of dexamethasone versus prednisolone in controlling asthma exacerbations in children.MethodsWe recruited 60 patients with asthma exacerbation, aged 2–11 years. Participants were randomly divided into three groups (20 patients each). Group I received a single dose of oral dexamethasone 0.3 mg/kg (maximum 12 mg), group II received 0.6 mg/kg/day of oral dexamethasone for 2 days (maximum 16 mg/day) and group III received 1.5 mg/kg/day oral prednisolone for 5 days (maximum 60 mg/day). Our primary outcomes were changes in Paediatric Respiratory Assessment Measure (PRAM), eosinophilic count and serum immunoglobulin E on day 5. Secondary endpoints were reporting any adverse effects and relapse rate during the 5 days. After 30 days, the Asthma Therapy Assessment Questionnaire (ATAQ) was given to the parents of the recruited patients.ResultsAmong the three study groups, there was a highly statistically significant difference in IgE level, saturated oxygen, peak expiratory flow, forced expiratory volume in 1 s/forced vital capacity, PRAM and Modified Pulmonary Index Score; however, the eosinophilic count was significantly lower within the same group. Vomiting, gastrointestinal tract cramps, ATAQ and relapse rate showed a non-statistically significant difference.ConclusionSingle-dose dexamethasone was at least as effective as 5-day course of prednisolone in controlling asthma, while dexamethasone for 2 days was non-inferior to 5 days of prednisolone in children with asthma exacerbation.

Oral Dexamethasone vs. Oral Prednisone for Children With Acute Asthma Exacerbations: A Systematic Review and Meta-Analysis

“…Three studies evaluated intramuscular dexamethasone vs. prednisone and hence were excluded (9,11,12). A total of seven unique articles were included in this systematic review and meta-analysis (1,7,13,(18)(19)(20)(21).…”

“…Details of individual studies are presented in Table 1. There were six RCTs (1,13,(18)(19)(20)(21) and one quasi-RCT (7). All trials included pediatric patients, however, the age group varied across studies.…”

“…One study excluded patients with severe asthma exacerbation (18). One included patients with moderate severity of exacerbation only (1) while another study included patients with moderate to severe exacerbations (19). Asthma severity was measured on different scales across trials.…”

“…Dexamethasone was administered as a 1-day (1,13,18) or 2-days therapy (7,20,21). In one trial, patients were randomized into three groups of 1-day dexamethasone, 2-days dexamethasone, and prednisone (19). Data of both dexamethasone groups were compared separately with prednisone in our meta-analysis.…”

“…Only three studies (1,18,20) provided sufficient information on blinding of participants and personnel while only two trials (1,18) reported blinding of outcome assessment. Attrition bias was found to be high in two studies (19,20).…”