Acute asthma presentations account for more than 2.1 million Emergency Department (ED) visits annually in the US. Current guidelines from the National Heart, Lung, and Blood Institute recommend a minimum of 5 days of oral prednisone to treat moderate to severe asthma exacerbations.There has been promising data on dexamethasone for acute asthma from the pediatric literature, as well as a 2-dose regimen in adults. Rehrer MW et al.conducted a Prospective, randomized, triple-blinded, controlled, noninferiority single center trial to ascertain whether a single dose of oral dexamethasone non-inferior to 5 days of oral prednisone in the treatment of adults with mild to moderate asthma exacerbations or not.The investigators found that A single dose of oral dexamethasone did not demonstrate noninferiority to prednisone for 5 days by a very small margin for treatment of adults with mild to moderate asthma exacerbations.
In the study researchers enrolled patients aged 18-55 years, with a history of asthma, who presented to the ED with an episode of acute asthma requiring more than 1 albuterol nebulizer treatment, and were discharged home.In the two groups one was put on 12mg of oral dexamethasone in the ED plus 4 days of placebo capsules.Control group of patients were put on Prednisone 60mg in ED plus 4 days of 60mg of prednisone.In all 1,677 patients were assessed for eligibility out of which 465 were randomized to either receive prednisone (238) or dexamethasone (227).Ultimately 376 were included in final analysis (follow up rate: 81%).Both groups had similar baseline characteristics, including age, sex, race or ethnicity, asthma severity history, home inhaled steroid use, vital signs, peak flow rates, and ED-based treatments.
It was found that the dexamethasone group by a small margin surpassed the preset 8% difference between groups for noninferiority in relapse rates within 14 days (12.1% versus 9.8%; difference 2.3%; 95% confidence interval –4.1% to 8.6%). Subjects in the 2 groups had similar rates of hospitalization for their relapse visit (dexamethasone 3.4% versus prednisone 2.9%; difference 0.5%; 95% confidence interval –4.1% to 3.1%). Adverse effect rates were generally the same in the 2 groups.
The researchers concluded that a single dose of oral dexamethasone did not demonstrate noninferiority to prednisone for 5 days by a very small margin for treatment of adults with mild to moderate asthma exacerbations. Enhanced compliance and convenience may support the use of dexamethasone regardless.
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Ann Emerg Med 2016. PMID: 27117874
Dr. Kamal Kant Kohli
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