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Question 1: Prednisolone or dexamethasone for acute exacerbations of asthma: do they have similar efficacy in the management of exacerbations of childhood asthma?
  1. Elisabeth Redman1,
  2. Colin Powell2
  1. 1 Department of Child Health, Noah's Ark Children's Hospital for Wales, Cardiff University, Cardiff, Wales, UK
  2. 2 Department of Child Health, Noah's Ark Children's Hospital for Wales, Institute of Molecular and Experimental Medicine, Cardiff University, Cardiff, Wales, UK
  1. Correspondence to Dr Colin Powell, Department of Child Health, Noah's Ark Children's Hospital for Wales, Institute of Molecular and Experimental Medicine, Cardiff University, Cardiff, Wales CF14 4XW, UK; Powellc7{at}cardiff.ac.uk

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Scenario

You are asked to see a 6-year-old child who has come into hospital with an acute exacerbation of asthma. She is able to talk in full sentences, however, her respirations are 40/min with audible wheeze, and you prescribe 10 puffs of salbutamol as initial management. The British Thoracic Society (BTS) guidelines recommend early use of steroids to decrease admission rate and length of stay,1 and you feel steroids would be of value for this child. However the mother of your patient explains her daughter hates taking any medications. You have read an article about dexamethasone being a shorter treatment course with better compliance and wonder if it has similar efficacy to prednisolone.

Question

In children who have an acute exacerbation of asthma requiring steroids (population), does dexamethasone (intervention) have similar efficacy to prednisolone (comparison) in achieving decreased airway inflammation, decreased admission rates and length of hospital stay (outcome)?

Search strategy and outcome

Medline (1996 to September week 2 2012) and Embase (1996 to 20 September 2012) were searched via Ovid on 21 September 2012 using the search terms ((dexamethasone AND prednisolone) or (dexamethasone AND prednisone)) AND ((acute asthma) OR (asthma exacerbation)). A total of 82 abstracts were reviewed, and six relevant studies were found: five papers were identified after review of …

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