Author: Dr. Willeed Rabah
Background:
- Shortness of breath is a common presenting symptom to the Emergency department in Pediatric patients. Many times, asthma is the leading cause. Depending on severity of the asthma symptoms, steroids are often used in the management of these patients. This study compares two different orally given steroids, the first prednisolone and dexamethasone, the later being longer acting. In theory, a longer acting medication would require less follow up management. I think this is study is significant, as it may improve outcomes in those who do not have access to healthcare after the initial emergency department visit.
Design:
- This study enrolled patients over the course of 1 year in a pediatric emergency department in Ireland. This study was a randomized control study meaning, patients were randomized into the prednisolone therapy group or the dexamethasone group. The prednisolone group received 3 days of drug therapy, while dexamethasone group received one dose of medication on initial presentation to the ED. A scoring system (PRAM) was utilized to compare outcomes of the two therapies after 4 days of initial administration of the medications.
Results:
- Both arms of the study (Prednisolone and Dexamethasone) had the same PRAM score on Day 4 after initial presentation to the ED ( PRAM score of .91). This means that, clinically, there was no difference in patient outcomes in the two different groups.
Discussion:
- I believe this study was effective at demonstrating the similarity between the two medications. This study will impact the way I manage asthma patients in the future. I think administrating dexamethasone would be easier for families of the patient. I think dexamethasone would also be beneficial to patients who’s family may not be able to afford prescription medication as they would still need two more doses of the prednisolone outside the hospital.
- There were limitations to the study as the scoring system may have been inconsistent as it is a subjective scoring system. Other limitations include, including patients that were admitted to the hospital, these patient may have had better management thus decreasing the PRAM score compared to patients who were sent home.
Take Away: One dose of oral Dexamethasone is as good as 3 doses of oral Prednisolone for the management of acute asthma exacerbation in Pediatric patients.
Reference:
○ Cronin JJ, McCoy S, Kennedy U, An Fhailí SN, Wakai A, Hayden J, Crispino G, Barrett MJ, Walsh S, O’Sullivan R. A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department. Ann Emerg Med. 2016 May;67(5):593-601.e3. doi: 10.1016/j.annemergmed.2015.08.001. Epub 2015 Oct 14. PMID: 26460983.