Written by Kimiko Dunbar
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This meta-analysis found no significant difference in efficacy in commonly used corticosteroid options (various regimens of dexamethasone or prednisolone) for treatment of pediatric acute asthma exacerbation.
Hit refresh on your management – say hello to corticosteroid light!
Most clinicians are using dex vs. prednisolone these days, as we covered yesterday. Prior meta-analyses assessing dexamethasone vs. prednisolone have found no significant difference between the use of short-term dexamethasone and 3-5 days of prednisolone in management of acute asthma exacerbation; however, these studies group dexamethasone and prednisolone broadly, regardless of dose, route, or duration.
This systematic review and network meta-analysis evaluated the comparative effectiveness of oral corticosteroids for pediatric acute asthma exacerbations. Fifteen trials (3,989 children) were analyzed. Authors compared 6 different regimens: dexamethasone (DEXA) 0.3 mg/kg/day x 1 day, DEXA 0.6 mg/kg/day x 1 day, DEXA 0.6 mg/kg/day for 2 days, prednisolone (PSL) 1.0 mg/kg/day for 3 days, PSL 1.0-1.5 mg/kg/day x 5 days and PSL 2.0 mg/kg/day x 5 days. No corticosteroid regimen significantly differed in relapse risk. Vomiting rates were significantly lower with dexamethasone (OR 0.29, 95%CI 0.16–0.52) vs. prednisolone. This meta-analysis is limited by the quality of the studies included – some trials were quite small, and several RCTs had high risk of bias due to their randomization process or missing outcome data.
How does this change my practice?
I’m dexamethasone ride or die, so this won’t change my practice too much. I always prescribed 0.6 mg/kg/dose; a single dose of 0.3 mg/kg of dex seems too good to be true. We need a lot more research to validate this. Further, I’d be interested to compare 2 doses of 0.6 mg/kg dexamethasone to a 7-day course of prednisolone.
Source
Oral systemic corticosteroids in children with acute asthma exacerbations: a systematic review and network meta-analysis. Arch Dis Child. 2025 Jun 8:archdischild-2024-327523. doi: 10.1136/archdischild-2024-327523. Epub ahead of print. PMID: 40484453
