Comparison of Oral Dexamethasone Doses in Asthma Exacerbation
Condition: Asthma; Reactive Airway Disease
MeSH terms: Asthma
Study type: Interventional

Summary: 
      Hypothesis: A 2-day course of oral dexamethasone is the superior option for the resolution of
      symptoms and prevention of relapse in the emergency department (ED) management of
      mild-moderate asthma exacerbations.
    

Detailed description: 
      Asthma has become a major public health problem of increasing concern in the US as it is the
      most prevalent chronic disease of childhood with over 6 million children under the age of 17
      affected 7. Low-income populations, minorities, and children living in inner cities
      experience disproportionately higher morbidity and mortality due to asthma. Children who
      suffer from asthma often present to the ED or outpatient center for management of their
      symptoms and exacerbations. Asthma related ED visits in 2004 were estimated at 1.8 million,
      with children younger than 17 accounting for almost half with 754,000 visits 7 Recent
      clinical trials have shown the efficacy of dexamethasone in the ED management of asthma. In
      Quereshi et al, a randomized study of 533 patients showed that two doses of DEX taken on days
      1 and 2 were equally efficacious as 5 days of prednisolone2. However, patients treated with
      DEX demonstrated improved compliance with less vomiting, fewer missed days of school and
      fewer missed parental workdays. A more recent study by Altamimi et al compared single dose
      DEX to 5-day prednisolone1. This double blinded, randomized prospective study of 134 children
      concluded that single dose DEX is no worse than 5 days of prednisolone as well.dexamethasone
      in the acute management of asthma exacerbation. However, practices vary as to the use of
      single dose, two-day dosing and when to administer the second dose. The purpose of this study
      is to compare various dosing regimes of dexamethasone in its efficacy in the treatment of
      asthma exacerbations. Given the longer duration of action of DEX (36-72 hours), we
      hypothesize that 2 doses of DEX given on days 1 & 3 are superior to single dose DEX in
      improving symptoms and preventing relapse in the ED management of mild to moderate asthma
      exacerbations.

      These previous studies show similar efficacy of dexamethasone when compared to the standard
      5-day prednisone/prednisolone treatment. . Within the institution, the investigators have
      incorporated the use of dexamethasone in the management of acute asthma exacerbations.
      However, practices vary as to the use of a single dose, two-day dosing and the timing of the
      second dose for those patients receiving two doses of dexamethasone.

      The purpose of this study was to determine if single dose oral dexamethasone is as effective
      as a 2 dose course of oral dexamethasone in preventing relapse within 7 days for pediatric
      asthma patients managed in the ED. Given the long half life of dexamethasone, the
      investigators hypothesized that 2 doses given on days 1 and 3 are superior to single dose in
      improving symptoms and preventing relapse in the ED management of mild to moderate asthma
      exacerbations.
    

Intervention name(s): Dexamethasone; Dexamethasone
Intervention type(s): Drug; Drug
Intervention description(s): Single loading dose in ED 0.6 mg/kg, rounded to nearest 2 mg,use 4 mg tabs max dose 16 mg.; Firstdose in ED 0.6 mg/kg, rounded to nearest 2 mg, use 4 mg tabs max dose 16 mg; a prescription for second dose as above to be taken on day 3 after discharge
Other intervention name(s): Decadron; Decadron
Intervention MeSH terms: Dexamethasone; Dexamethasone acetate; BB 1101
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Asthma; Dexamethasone; Emergency Department