Asthma in the ER: Single-Dose Dexamethasone vs. 5-Day Course of Prednisone
The rate of relapse was found to be only slightly higher in asthma patients treated with a single dose of oral dexamethasone in the ER versus a 5-day course of prednisone, indicating that higher compliance and convenience may support dexamethasone use, a recent article in Annals of Emergency Medicine reported.
Matthew W. Rehrer, MD, of Kaiser Permanente, Oakland, CA, and colleagues evaluated whether a single dose of oral dexamethasone plus placebo for 4 days was noninferior to oral prednisone for 5 days in treating adults with mild to moderate asthma exacerbations to prevent relapse. A relapse was defined as "an unscheduled return visit for additional treatment for persistent or worsening asthma within 14 days."
They randomized adult patients admitted to the emergency department aged 18-55 years to either a single dose of oral dexamethasone 12mg with 4 days of placebo (n=173) or oral prednisone 60mg daily for 5 days (n=203). Researchers measured study outcomes, including relapse, via follow-up telephone interview at 2 weeks.
The results showed the dexamethasone arm passed the preset 8% noninferiority difference between the two groups in relapse rates within 14 days (12.1% vs. 9.8%; difference 2.3%; 95% CI: -4.1% to 8.6%). Study patients in both arms exhibited similar rates of hospitalization for relapse (3.4% [dexamethasone] vs. 2.9% [prednisone]; difference 0.5%; 95% CI: 4.1% to 3.1%). In addition, rates of adverse events were similar between the two groups.
Dr. Rehrer noted that single-dose dexamethasone did not show noninferiority to prednisone "by a very small margin," but "enhanced compliance and convenience" may support its use regardless.
"In my personal experience as an emergency physician, I had many asthmatic patients relapsing because they were unable to fill their prednisone prescriptions," said Dr. Rehrer. "For those patients and others like them, I might prefer to administer dexamethasone because it eliminates for them the burden of having to fill the prescription and remember to take it for the next four days. When it comes to patient compliance, convenience counts."
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