Diseases, Conditions, Syndromes

Evidence suggests dexamethasone is a better choice than prednisolone for acute asthma attacks in children

In children with asthma attacks, (1) giving a steroid is better than not giving a steroid; (2) giving a dose of steroid early (preferably within the first hour of arrival) is better than giving it late; and (3) education and empowerment of children and their families is crucial. These points are more important than which oral steroid is used. Notwithstanding this I hope to explain why the evidence backs my opinion that dexamethasone is a better choice than prednisolone for acute asthma in children. In the regional children’s hospital in which I work, we started using dexamethasone for acute asthma in September 2016, as part of a refresh of local guidelines.

The first consideration is effectiveness of the two drugs. The best way to evaluate this is using meta-analysis of clinically relevant outcomes in randomised controlled trials (RCTs). When developing our guidelines we asked parents, nurses, and doctors from general paediatric and emergency medicine backgrounds which outcomes were of most interest. They highlighted that switching to dexamethasone would not be acceptable if it was less effective than prednisolone at preventing admission from the emergency department (ED), or if it carried a higher risk of readmission. We identified one meta-analysis from 2014 in which the pooled results of six RCTs did not show a difference in any efficacy outcome between dexamethasone and prednisolone when given in ED, including the need for admission during the initial ED visit, or relapse of acute …

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