Written by Kimiko Dunbar
Spoon Feed
Dexamethasone use for acute asthma exacerbation rose from 9% to 95% between 2013 – 2024. Compared to prednisone/prednisolone, dexamethasone was associated with slightly higher odds of ED return (aOR 1.07) but lower odds of hospitalization within 7 days (aOR 0.90).
2014, a great year for Dex
Multiple studies over the past 3 decades have supported the efficacy of dexamethasone vs. prednisone/prednisolone for the management of acute asthma exacerbation. As such, there has been a shift toward increasing dexamethasone use with little understanding of the downstream impact. This retrospective cross-sectional study assessed corticosteroid trends in 491,576 pediatric ED discharges for asthma across 28 hospitals (20102-024). Dexamethasone use rose from 9% to 95%, with the inflection point between 2013-2015. Compared to prednisolone/prednisone, dexamethasone was associated with slightly higher odds of ED return (aOR 1.07, 95%CI 1.03–1.11) but lower odds of hospitalization within 7 days of the visit (aOR 0.90, 95%CI 0.84–0.97). Limitations include lack of dosing details (we don’t know if patients were prescribed a 2nd dose of dex 24 hours later or discharged home after a single dose) and lack of information on clinical severity.
How does this change my practice?
This study is really all about how evidence ultimately makes its way into clinical practice. According to this study, a timeframe of 17 years is the typical amount of time it takes for evidence to make its way into clinical practice! Interestingly, a meta-analysis that was published in Pediatrics in 2014 may have contributed to the rapid uptake during that time. I’m hopeful that increased access to emerging evidence (hello, JournalFeed!) will speed up this timeline but, wow… we are slow to change. As far as dex vs. pred goes, I’ll keep prescribing dex, given the large body of work supporting its non-inferiority and the clear advantages of a 1- or 2-dose regimen.
Source
Adoption of Dexamethasone for Asthma Exacerbations. Pediatrics. 2025 Jun 5:e2024070153. doi: 10.1542/peds.2024-070153. Epub ahead of print. PMID: 40467067
