Dexamethasone may offer pediatric asthma alternative

Dexamethasone may be an adequate replacement for prednisone or prednisolone in treating pediatric asthma exacerbations, offering patients a shorter course of treatment with fewer side effects and increased compliance, according to a new report.

"There are several emergency department papers that found dexamethasone equally as effective as prednisone," says Kavita Parikh, MD, MSHS, lead author of the report, published in the Journal of Pediatrics. "There is a benefit for clinical practice in that it offers a more patient-centered approach."

Asthma exacerbations are the second most common reason for pediatric hospital admissions, with more than 137,000 admissions related to asthma in 2009 alone, according to the report.

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These exacerbations are typically treated on an inpatient basis with prednisolone or prednisone, a short-acting corticosteroid that is often administered in the form of an oral tablet or syrup in pediatric patients. However, long-term side effects include vomiting and its bitter taste may reduce patient compliance with a full course of treatment.

Dexamethasone is a long-acting corticosteroid option that can be administered as a full course of one dose or two doses over two days but has the same effect as a five-day course of prednisone or prednisolone, the study notes.

Additionally, the study indicates that dexamethasone may be better absorbed than prednisone or prednisolone.

"Dexamethasone has a greater affinity for the glucocorticoid receptor compared with methylprednisolone, prednisolone, or prednisone, and is five times more potent when receptor affinity and pharmacokinetics are considered together," the study notes. "Dexamethasone is also well-absorbed by both oral and intramuscular routes of administration."

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The study noted, however, that one intramuscular dose of dexamethasone did not appear to be as effective as a five-day course of prednisolone or prednisone. A two-day course of oral dexamethasone was deemed to be equally as effective as a five-day course of prednisolone or prednisone.

Dexamethasone has also been considered to be more palatable that prednisone or prednisolone, with less frequency of vomiting as a side effect, therefore improving compliance with a full course of treatment, the study notes.

Parikh told Medical Economics that by using dexamethasone, patients can complete their treatment during their hospital stay, without the need for an additional outpatient prescription. When prednisone or prednisolone are used, Parikh says patients will typically have two days of treatment in the hospital, plus an additional three days at home. In too many cases, however, patients never complete the outpatient portion of their treatment for whatever reason, she says.

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Dexamethasone may still cause vomiting and other side effects common to corticosteroids, such as weight gain or hair loss, but Parikh says the frequency and duration of these side effects seem to be lessened by dexamethasone offering a short course of treatment.

Additionally, the cost of care was significantly reduced in patients treated with dexamethasone compared to prednisone or prednisolone due to shorter hospital stays and fewer readmissions, Parikh says.

Although the study involved only inpatient cases, Parikh says there could be indications for outpatient use with additional research.

"I think that there is a good basis of research in the emergency department that may translate to the applicability of asthmatic exacerbation in primary care offices, but more research would be needed to demonstrate that," she says.