Scenario

A 5-year-old boy presents to the emergency department (ED) with an acute exacerbation of asthma, is assessed as having a tight chest and has an oxygen requirement. He is followed up regularly in a paediatric respiratory clinic and is normally on a preventer inhaler. Along with back-to-back mixed nebulisers, you prescribe oral prednisolone, which he vomits 10 min later.

The paediatric specialty trainee  says she has heard of a recent randomised controlled trial (RCT) that shows that a single dose of oral dexamethasone is as good as 3 days of prednisolone in the management of acute wheeze, and you know from your own experience that oral dexamethasone is usually well tolerated by kids presenting with croup. Given how often you see children vomit prednisolone, you ask yourself whether the ED should switch to oral dexamethasone instead for childhood wheeze.

Structured clinical question

For (children presenting to the ED with wheeze and who require steroid …