Single-Dose Dexamethasone vs 5 Days of Prednisone in Acute Adult Asthma | PracticeUpdate
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Dexamethasone vs. prednisone: Differences, similarities, and which is better for you - You are here
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Adults presenting to the emergency department with a mild or moderate exacerbation of asthma were randomized to receive a single dose of dexamethasone with 4 days of placebo or 5 days of oral prednisone. Dexamethasone failed to demonstrate noninferiority to prednisone by a small margin for preventing relapse at 14 days; however, but there were similar rates of hospitalization for relapse and adverse events in the two groups.
The duration of action of dexamethasone is three times as long as that of prednisone and lasts up to 72 hours; 5 mg of prednisone are equal to 0. For adults with an asthma exacerbation, this study randomized patients to a one-time dose of 12 mg of dexamethasone orally followed by 4 days of placebo or 60 mg of prednisone daily for 5 days. The convenience of this dosing increased compliance, which improves the effectiveness of therapy reducing the cost for treating a relapse.
Oral and intramuscular injection of dexamethasone are equivalent. Oral dexamethasone demonstrates bioavailability similar to that of oral prednisone but has a longer half-life. We evaluate whether a single dose of oral dexamethasone plus 4 days of placebo is not inferior to 5 days of oral prednisone in treatment of adults with mild to moderate asthma exacerbations to prevent relapse defined as an unscheduled return visit for additional treatment for persistent or worsening asthma within 14 days.
Adult emergency department patients aged 18 to 55 years were randomized to receive either a single dose of 12 mg of oral dexamethasone with 4 days of placebo or a 5-day course of oral prednisone 60 mg a day. Outcomes including relapse were assessed by a follow-up telephone interview at 2 weeks. One hundred seventy-three dexamethasone and prednisone subjects completed the study regimen and telephone follow-up.
Subjects in the 2 groups had similar rates of hospitalization for their relapse visit dexamethasone 3. Adverse effect rates were generally the same in the 2 groups. A single dose of oral dexamethasone did not demonstrate noninferiority to prednisone for 5 days by a very small margin for treatment of adults with mild to moderate asthma exacerbations.
Enhanced compliance and convenience may support the use of dexamethasone regardless. Property Value Status. We have detected that you are using an Ad Blocker. PracticeUpdate is free to end users but we rely on advertising to fund our site. Please consider supporting PracticeUpdate by whitelisting us in your ad blocker. We have sent a message to the email address you have provided.
If this email is not correct, please update your settings with your correct address. The email address you provided during registration,does not appear to be valid. Please update your settings with a valid address before to continue using PracticeUpdate. Close Back. Sign in. Join now. Follow us on:. Search PracticeUpdate Cancel. While a single dose of dexamethasone did not demonstrate noninferiority to 5 days of prednisone for a mild to moderate exacerbation of asthma, outcomes appear comparable and further research may support the use of dexamethasone.
Primary Care Written by. Dexamethasone vs prednisone for asthma flare The duration of action of dexamethasone is three times as long as that of prednisone and lasts up to 72 hours; 5 mg of prednisone are equal to 0. Adult dosing of dexamethasone for various inflammatory conditions: Asthma exacerbation, 12 mg Multiple sclerosis exacerbation, 30 mg Allergic reaction, 8 mg High-altitude cerebral edema, 8 mg References Rehrer MW, Liu B, Rodriguez M, et al.
Ann Emerg Med. A cost-effectiveness analysis of dexamethasone versus prednisone in pediatric acute asthma exacerbations. Acad Emerg Med. This abstract is available on the publisher's site. METHODS Adult emergency department patients aged 18 to 55 years were randomized to receive either a single dose of 12 mg of oral dexamethasone with 4 days of placebo or a 5-day course of oral prednisone 60 mg a day.
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Early use of oral steroid therapy is also recommended with prednisone being the drug of choice 6. Relapse after prednisone therapy has been attributed to several factors like the unpleasant bitter taste of the drug, side-effects like vomiting, and its multi-dose regimen of 3—5 days which may reduce patient compliance 8 — To improve patient compliance and reduce relapse rates, the role of dexamethasone has been evaluated in many trials 4 , 7.
Initial studies evaluating a single dose of intramuscular IM dexamethasone have found it to be as effective as a 3—5 day regimen of prednisone 11 , Subsequently, studies have also compared oral 1 or 2-day therapy of dexamethasone against a 3—5 days regimen of oral prednisone 4 , Oral formulations are desirable in children as they are associated with less pain.
To date, two meta-analyses have compared oral dexamethasone and prednisone for acute exacerbations of asthma in children, with the last literature search performed in April 3 , 4. Due to the limited number of studies analyzed in these previous reviews, this study aimed to provide an updated Level 1 evidence on relapse rates and adverse effects of oral dexamethasone vs.
Studies including adult asthma patients and utilizing the parenteral route of administration of dexamethasone or prednisone were excluded.
We also excluded non-randomized studies, retrospective studies, case-series, and non-English language studies. The last literature search was conducted on 1st August After assessing the studies by their titles and abstracts, full-texts of selected articles were retrieved. Both the reviewers assessed individual studies based on inclusion criteria.
Disagreements, if any, were resolved by mutual agreement. Using an abstraction form, two reviewers retrieved data from selected studies. The primary outcome was the relapse rate defined by an unscheduled visit to the ED or clinic. Secondary outcomes were hospital readmission after discharge and incidence of vomiting at ED or home.
Every study was evaluated for the following variables: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other biases. We rated studies on each variable as low risk, high risk, or unclear risk of bias.
Anticipating heterogeneity amongst studies, a random-effects model was used to calculate the pooled effect size. Heterogeneity was calculated using the I 2 statistic. A sensitivity analysis was carried out to assess the influence of each study on the pooled effect size. Sub-group analysis was conducted for relapse rates based on follow-up period 1—5 days or 10—15 days and dosage of dexamethasone. Using the method described by Muncer et al. Gpower software was used to calculate the power of studies.
Out of the potentially relevant articles, 10 were selected for full-text analysis Figure 1. Three studies evaluated intramuscular dexamethasone vs. A total of seven unique articles were included in this systematic review and meta-analysis 1 , 7 , 13 , 18 — Details of individual studies are presented in Table 1. All trials included pediatric patients, however, the age group varied across studies.
All studies were performed in the ED with varying sample sizes 23— patients. One study excluded patients with severe asthma exacerbation One included patients with moderate severity of exacerbation only 1 while another study included patients with moderate to severe exacerbations Asthma severity was measured on different scales across trials.
With an exception of one study 20 , there was no statistical significant difference between asthma severity scores of the two study groups. Dexamethasone was administered as a 1-day 1 , 13 , 18 or 2-days therapy 7 , 20 , In one trial, patients were randomized into three groups of 1-day dexamethasone, 2-days dexamethasone, and prednisone Data of both dexamethasone groups were compared separately with prednisone in our meta-analysis.
The dosage of dexamethasone in the included studies was 0. Majority studies had an institutional asthma management protocol wherein additional drugs were given to all patients of the trial. Prednisolone is the most commonly used corticosteroid in treatment of asthma exacerbation.
Oral dexamethasone demonstrates bioavailability similar to that of oral prednisolone but has a longer half-life. Objective To evaluate in adouble-blind,randomised clinical trial the efficacy of different doses of dexamethasone versus prednisolone in controlling asthma exacerbations in children. Methods We recruited 60 patients with asthma exacerbation, aged 2—11 years. Participants were randomly divided into three groups 20 patients each. Dexamethasone vs prednisone for asthma flare The duration of action of dexamethasone is three times as long as that of prednisone and lasts up to 72 hours; 5 mg of prednisone are equal to 0.
Adult dosing of dexamethasone for various inflammatory conditions: Asthma exacerbation, 12 mg Multiple sclerosis exacerbation, 30 mg Allergic reaction, 8 mg High-altitude cerebral edema, 8 mg References Rehrer MW, Liu B, Rodriguez M, et al. Ann Emerg Med. A cost-effectiveness analysis of dexamethasone versus prednisone in pediatric acute asthma exacerbations.
Acad Emerg Med. This abstract is available on the publisher's site. METHODS Adult emergency department patients aged 18 to 55 years were randomized to receive either a single dose of 12 mg of oral dexamethasone with 4 days of placebo or a 5-day course of oral prednisone 60 mg a day.
Additional Info. Often, the directions will specify that you start with a higher dose and then taper down to a lower dose. Steroids like dexamethasone or prednisone should be taken with food to reduce stomach side effects. The tables below outline standard dosages for some of the conditions that these steroids treat. More detailed information on dosing can be found for dexamethasone and prednisone on our dosing pages. Sources: Dexamethasone , Prednisone. Steroid dosing for children varies by weight and the condition being treated.
Note: Doses listed in the tables above are standard doses per condition. Starting and maximum doses vary by drug and indication. The tables above are not a complete list of all possible indications or doses for dexamethasone or prednisone. Your healthcare provider will determine the best dosage for you based on your health condition and response to treatment. Unless the patient requires oxygen, using a steroid does not benefit the patient and can cause serious side effects such as high blood sugar, stomach bleeding, psychosis, infections, and other long-term effects.
Patients who are already taking a corticosteroid for another indication should continue treatment under supervision of their healthcare provider. In patients who are hospitalized and have suspected or confirmed severe COVID , and are on oxygen or a ventilator, a steroid may be used if the healthcare provider determines it will be useful.
If dexamethasone is used, the dose is usually 6 mg by mouth or IV daily. If dexamethasone is not available and prednisone is used, the dosage is usually 40 mg daily. When taking a steroid such as dexamethasone or prednisone, your healthcare provider will provide instructions for gradually tapering the medication over some time depending on how long you took the medicine.
Steroids must always be tapered if taken for more than a few days. If your total time taking the steroid is a week or so, you will only taper for the last few days of the week.
However, if you took steroids for many months, your healthcare provider will instruct you to taper much more gradually, over several weeks or even months. This is because prednisone affects the adrenal glands , so stopping the medicine slowly allows the adrenal glands to return to their normal function.
Stopping a steroid too quickly can cause withdrawal symptoms such as extreme tiredness, weakness, lightheadedness, body aches, joint pain, nausea, and appetite loss.
Sign up for prednisone price alerts and find out when the price changes! When you are prescribed a steroid medication, it is important to take the medication as directed, and taper the dose as directed by your healthcare provider when instructed to do so. Below is a list of potential side effects that may occur with either dexamethasone or prednisone.
This is not a full list of side effects. Consult your healthcare provider for a full list of adverse events. Source: DailyMed dexamethasone , DailyMed prednisone. Patients taking an anticoagulant , such as warfarin, should be monitored while taking steroid medication. Medications used for diabetes may need to be adjusted because steroids may affect blood glucose levels.
Certain medications that are metabolized by an enzyme called CYP3A4 may affect the metabolism of the steroid, requiring dosage adjustment. This is not a full list of drug interactions. Consult your healthcare provider for a full list of drug interactions. Pioglitazone Antidiabetic agents Yes Yes Carbamazepine. These steroids should not be mixed with alcohol. Combining steroid medication with alcohol can lead to a higher risk of stomach ulcers, perforation, and bleeding.
Google Scholar. Christine L. Schuler, MD ; Christine L. Schuler, MD. Carolyn M. Kercsmar, MD ; Carolyn M. Kercsmar, MD. Katherine A. Auger, MD, MSc. Hosp Pediatr 12 3 : — Cite Icon Cite. Comments 0 Comments.
Introduction Asthma is one of the most prevalent chronic respiratory diseases, which often leads to an emergency department visit. Prednisolone is the most commonly used corticosteroid in treatment of asthma exacerbation. Oral dexamethasone demonstrates bioavailability similar to that of oral prednisolone but has a longer half-life. Objective To evaluate in adouble-blind,randomised clinical trial the efficacy of different doses of dexamethasone versus prednisolone in controlling asthma exacerbations in children.
Methods We recruited 60 patients with asthma exacerbation, aged 2—11 years. Participants were randomly divided into three groups 20 patients each. Group I received a single dose of oral dexamethasone 0.
Vomiting, gastrointestinal tract cramps, ATAQ and relapse rate showed a non-statistically significant difference. You will be able to get a quick price and instant permission to reuse the content in many different ways.
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You are here Home Archive Volume 27, Issue 3 Two regimens of dexamethasone versus prednisolone for acute exacerbations in asthmatic Egyptian children. Email alerts. Article Text. Article menu. Original research. Two regimens of dexamethasone versus prednisolone for acute exacerbations in asthmatic Egyptian children. Abstract Introduction Asthma is one of the most prevalent chronic respiratory diseases, which often leads to an emergency department visit.
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localhost › GoodRx Health › Drug Classes › Corticosteroids. Dexamethasone is long-acting medication and is considered to be a potent, or strong, steroid. It is 6 times more potent (strong) than prednisone. Can prednisone. Summary for Corticosteroid. Prescription only. Dexamethasone is a long-acting oral corticosteroid that is effective in treating allergic reactions and immune. Dexamethasone can be given for 1 to 5 days at a dose ranging from to mg/kg daily. Dexamethasone is a long-acting glucocorticoid with a half-life of Dexamethasone has a six- to sevenfold higher efficacy than prednisone in terms of antiinflammatory effects,3 which traditionally led to dexamethasone/prednisone. Butler K, Cooper WO. Despite intra-venous dexamethasone and prednisone demonstrating similar efficacy for preventing nausea and vomiting after chemotherapy 28the unpleasant taste of oral prednisone frequently results in vomiting especially in children Skip Nav Destination Article Navigation.Disclaimer » Advertising. Erik R. Hoefgen, Bin Huang, Christine L. Schuler, Carolyn M. Hosp Pediatr March ; 12 3 : — Dexamethasone is increasingly used for the management of children hospitalized with asthma in place of prednisone, yet data regarding the effectiveness of dexamethasone in children with asthma exacerbation severe enough to require hospitalization are limited.
Our objective is to compare the effectiveness of dexamethasone versus prednisone in children hospitalized with an asthma exacerbation on day reutilization. A covariate-balanced propensity score was derived to account for physician discretion in steroid selection. A generalized linear model, including inverse probability treatment weighting, was used to detect differences in day return utilization unplanned readmission or emergency department visit between children whose first dose of corticosteroid was dexamethasone versus prednisone.
The total cohort had a mean age of 8. The covariate-balanced cohort had no significant differences in demographic characteristics or illness severity between groups. The dexamethasone group had a return utilization of 3. The propensity score-adjusted analysis revealed the steroid treatment was not found to significantly affect the day reutilization adjusted odds ratio [aOR] 1.
The initial steroid choice dexamethasone versus prednisone was not associated with day reutilization after hospitalization for an asthma exacerbation. Advertising Disclaimer ». Sign In or Create an Account. Search Close. Shopping Cart. Create Account. Advanced Search. Skip Nav Destination Article Navigation.
Close mobile search navigation Article navigation. Volume 12, Issue 3. Previous Article Next Article. Article Navigation. Research Articles February 07 Hoefgen, MD, MS. Louis, Missouri. Louis, MO This Site. Google Scholar. Christine L. Schuler, MD ; Christine L. Schuler, MD.
Carolyn M. Kercsmar, MD ; Carolyn M. Kercsmar, MD. Katherine A. Auger, MD, MSc. Hosp Pediatr 12 3 : — Cite Icon Cite. Comments 0 Comments. Comments 0. View full article. Sign in Don't already have an account? Individual Login. Institutional Login. Sign in via OpenAthens. Pay-Per-View Access.
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