Two days of dexamethasone versus 5 days of prednisone in the treatment of acute asthma: a randomized controlled trial.
Author(s): Kravitz J, Dominici P, Ufberg J, Fisher J, Giraldo P
Affiliation(s): Department of Emergency Medicine, Community Medical Center, St. Barnabas Health System, Toms River, NJ 08755, USA. firstname.lastname@example.org
Publication date & source: 2011-08, Ann Emerg Med., 58(2):200-4. Epub 2011 Feb 18.
Publication type: Comparative Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
STUDY OBJECTIVE: Dexamethasone has a longer half-life than prednisone and is well tolerated orally. We compare the time needed to return to normal activity and the frequency of relapse after acute exacerbation in adults receiving either 5 days of prednisone or 2 days of dexamethasone. METHODS: We randomized adult emergency department patients (aged 18 to 45 years) with acute exacerbations of asthma (peak expiratory flow rate less than 80% of ideal) to receive either 50 mg of daily oral prednisone for 5 days or 16 mg of daily oral dexamethasone for 2 days. Outcomes were assessed by telephone follow-up. RESULTS: Ninety-six prednisone and 104 dexamethasone subjects completed the study regimen and follow-up. More patients in the dexamethasone group reported a return to normal activities within 3 days compared with the prednisone group (90% versus 80%; difference 10%; 95% confidence interval 0% to 20%; P=.049). Relapse was similar between groups (13% versus 11%; difference 2%; 95% confidence interval -7% to 11%, P=.67). CONCLUSION: In acute exacerbations of asthma in adults, 2 days of oral dexamethasone is at least as effective as 5 days of oral prednisone in returning patients to their normal level of activity and preventing relapse. Copyright (c) 2011 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.