Single-Dose Oral Dexamethasone Compared with Three Day Course of Oral Prednisolone in Children with Moderate Exacerbation of Asthma-A Pilot Double-Blinded Randomised Controlled Trial

Abstract

Introduction: Corticosteroids are the mainstay of treatment for a child with acute exacerbation of asthma. Though, several guidelines suggest use of prednisolone for few days, recently single dose dexamethasone has been found to be equally efficacious. Studies comparing single dose dexamethasone with multiple doses of prednisolone in childhood asthma are lacking in India. Aim: To find out whether a single dose of dexamethasone is as efficacious as multiple doses of prednisolone in the management of moderate exacerbation of acute bronchial asthma in children. Materials and Methods: This is a double blinded, placebo controlled, pilot randomised controlled trial, conducted at a medical college and hospital in Southern India between November 2015 to August 2016. Sixty children aged two to twelve years diagnosed with moderate exacerbation of bronchial asthma, based on Paediatric Respiratory Assessment Measure (PRAM) score, were randomly divided into two groups of equal number; 30 children received a single dose of dexamethasone orally stat followed by second dose and third dose as placebo on days two and three while remaining 30 children received prednisolone for three days in single daily doses. The time taken for PRAM score to reach a value <2, number of bronchodilator nebulisations required and relapse within 24 hours of reaching PRAM<2 were assessed and analysed. Results: No statistically significant difference was found in the mean time (hours) required to attain PRAM score of <2 (prednisolone group 56.9±12.9 vs. dexamethasone group 58.6±11.5, p-value=0.3) and in the number of bronchodilator nebulisations required (prednisolone group 42.7±13.5 vs dexamethasone group 40.97±17.98, p-value=0.2). Conclusion: A single dose of oral dexamethasone is atleast as effective as three daily doses of prednisolone in children with moderate exacerbation of bronchial asthma. However, the results need to be confirmed with large randomised controlled trials in diverse settings.

Keywords

• child
• corticosteroids
• drug efficacy
• respiratory disease