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Can low-dose dexamethasone be used instead of prednisolone in acute asthma attacks?
  1. Susan Wallace1,
  2. Nigel IJ Chan2,
  3. Heidi Makrinioti1,
  4. Bob Phillips3
  1. 1 West Middlesex Hospital, Chelsea, and Westminster Foundation Trust, London, UK
  2. 2 Imperial College Healthcare NHS Trust Paediatrics, London, UK
  3. 3 Centre for Reviews and Dissemination, University of York Alcuin College, York, UK
  1. Correspondence to Dr Susan Wallace, Chelsea and Westminster Healthcare NHS Trust, London TW7 6AF, UK; susanwallace1{at}nhs.net

https://doi.org/10.1136/archdischild-2020-320239

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    Clinical scenario

    A girl aged 5 years presents to the paediatric A&E department with an asthma attack requiring oral steroids. Following inhaled salbutamol therapy, she keeps spitting out or vomiting the oral prednisolone despite repeat attempts of administration. The senior house officer asks about using dexamethasone, which is also an oral steroid preparation and when used in croup it is well tolerated by children. However, for her weight the dose of 0.6 mg/kg exceeds the recommended prednisolone equivalent. You consider whether a low dose of dexamethasone could be used successfully for an acute asthma attack.

    Question

    In children presenting with an asthma or wheeze attack requiring steroids (population), is a single dose of 0.3mg/kg oral dexamethasone (intervention) inferior to oral prednisolone (comparison) in time to discharge from emergency department, admission rates, length of hospital admission, escalation of management and hospital re-attendance (outcome)?

    Search strategy and outcome

    Medline (1946–19 May 2020) and Embase (1980–2020 week 20) using the search terms ((*steroid OR dexamethasone OR prednisolone) AND (asthma exacerbation OR acute …

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    Footnotes

    • Twitter @drbobphillips

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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