Study: One Dexamethasone Dose Matches Two for Pediatric Asthma

Systemic corticosteroids are a cornerstone of treatment for pediatric asthma exacerbations, but recent years have seen a massive shift away from traditional five-day courses of oral prednisone. Emergency department use of dexamethasone surged to 95.3 percent of encounters by 2024 in a study of 491,576 visits [1]. Clinicians have increasingly adopted dexamethasone because its longer biological half-life (the time it takes for the active drug concentration to decrease by half in the body) allows for shorter regimens that reduce noncompliance events (Odds Ratio 0.12, 95% Confidence Interval 0.04 to 0.34) and lower the risk of medication-induced vomiting (Risk Ratio 0.29, p < 0.00001) [2, 3]. Multiple meta-analyses encompassing over 5,000 patients have confirmed that short-course dexamethasone is just as effective as longer courses of prednisolone for preventing relapses, showing no significant difference in hospital readmission rates (Risk Ratio 0.90, 95% Confidence Interval 0.34 to 2.35) [4, 5]. However, while the superiority of the side-effect profile of dexamethasone is well established, the optimal dosing strategy remains a point of clinical variation. To address this gap, researchers recently investigated a cohort of 2,063 children to determine whether prescribing a second dose of dexamethasone upon emergency department discharge actually provides any additional clinical benefit over a single dose [6].