A comparison of efficacy and safety of a single dose of intramuscular dexamethasone acetate with oral prednisolone in the management of asthma exacerbations in children

Abstract EN

Background: Because corticosteroid improves pulmonary function, reduces the rate of hospitalization, and decreases the relapse rates in patients with acute asthma exacerbation, it is recommended for outpatient use after asthma exacerbation.????????? Objective: To determine whether a single intramuscular dexamethasone acetate injection is as effective as 5 days of oral prednisolone in improving symptoms and preventing relapse in children with acute asthma. Methods: This is a prospective, quasi, randomized, and non-blinded trial.

We enrolled 30 children, aged 9 months to 14 years with known history of asthma who presented to the emergency department with moderate exacerbation.

Patients were randomized to receive either a single intramuscular dexamethasone acetate injection or 5 days of oral prednisolone.

The primary out-come was to measure the rate of relapse, persistence, worsening, recurrence of symptoms and hospitalization in 5 and 21 days after discharge from emergency department. Results: All patients completed the study.

More patients in the prednisolone group continued to use bronchodilator than patients in the dexamethasone group (three patients in the former compared to one patient in the second group).

No patient in both groups had severe relapse or needed hospitalization.

Patients in the prednisolone group experienced difficulty in administration of the tablets and 3 of them missed 50-75% of the total dose.

There were no significant local or systemic adverse effects in both groups.

All patients in dexamethasone group were satisfied with the treatment while most parents in the prednisolone group preferred an alternative form of treatment. Conclusion: We found that IM dexamethasone acetate is more clinically effective than a 5-day course of oral prednisolone tablets in treatment of moderate asthma exacerbations.

It was well tolerated, and preferred by most parents.

We recommend it, as an alternative option especially in those who are not compliant to oral prednisolone.