Acute Asthma: Single-Dose Dexamethasone vs. 5-Day Prednisone

Summary and Comment |
April 29, 2016

Acute Asthma: Single-Dose Dexamethasone vs. 5-Day Prednisone

  1. Daniel J. Pallin, MD, MPH

A randomized trial suggests the regimens may be equivalent.

  1. Daniel J. Pallin, MD, MPH

Routine management of asthma exacerbations in emergency department patients includes a 5-day course of prednisone. Dexamethasone has a longer half-life, and prior research has suggested that a 1- or 2-day course of dexamethasone might be as good as a 5-day course of prednisone. Investigators randomized adults with mild-to-moderate acute asthma exacerbations to a single 12-mg dose of oral dexamethasone or 5 days of 60-mg prednisone daily.

Of 465 adult patients randomized, 376 completed the protocol and were analyzed. As assessed by telephone follow-up, relapse occurred in 12.1% of the dexamethasone patients and 9.8% of those on prednisone. The trial was designed as a noninferiority trial, and the upper limit of the 95% confidence interval surrounding the difference of 2.3% (−4.1% to 8.6%) was larger than the prespecified criterion for noninferiority, 8%. Therefore, the authors concluded that the single dose of dexamethasone was not equivalent to the 5-day course of prednisone.

Comment

This trial was limited by its very high rate of loss to follow-up. Nevertheless, its results are consistent with prior research, and therefore I conclude that a single dose of 12-mg dexamethasone by mouth seems a reasonable alternative to a 5-day course of prednisone for adults with acute asthma exacerbations. A larger trial with better follow-up would be worthwhile to confirm this conclusion, since this is such a common condition.

Editor Disclosures at Time of Publication

  • Disclosures for Daniel J. Pallin, MD, MPH at time of publication Grant / Research support NIH–National Center for Advancing Translational Sciences Leadership positions in professional societies Society for Academic Emergency Medicine (Co-Chair, Scientific Subcommittee of Program Committee, 2015–2016; Chair, Program Committee, 2017–2018)

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