This systematic review and meta-analysis aimed to determine whether intramuscular or oral dexamethasone is equivalent or superior to a 5-day course of … Hosp Pediatr. OBJECTIVES: Evidence supports using dexamethasone for mild-to-moderate asthma exacerbations in the emergency department, but the effectiveness of dexamethasone versus prednisone for asthmatic patients who are hospitalized is unclear. You may purchase access to this article. Keeney GE et al. 8600 Rockville Pike Pediatrics. Multiple myeloma: 2011 update on diagnosis, risk-stratification, and management [published correction appears in Am J Hematol. Please enable it to take advantage of the complete set of features! Contact your librarian or administrator if you do not have a username and password. Question 1: Is oral dexamethasone as good as oral prednisolone for childhood wheeze requiring steroids? Asthma affects 6.2 million children in the United States 1 and is the second most common reason for hospitalization in pediatrics. Dexamethasone for Pediatric Asthma Exacerbations: A Quality Improvement Intervention. Am J Hematol. The primary outcome of interest was return visits or hospital readmissions. Results: Comparative Effectiveness of Dexamethasone Versus Prednisone and Children Hospitalized With Asthma . GE Keeney, MP Gray, AK Morrison. Page 3 of 27 FIGURE 2. The role of inducible costimulatory molecular ligand (ICOSL) in children with neutrophilic asthma. This systematic review and meta-analysis aimed to determine whether intramuscular or oral dexamethasone is equivalent or superior to a 5-day course of oral prednisone or prednisolone. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Santiago Mintegi, MD, PhD, Natalia Paniagua, MD, PhD, Jose-Ignacio Pijoan, MD, MSc, Zaloa Gorostizaga, MD, Maria Gonzalez, MD, and Javier Benito, MD, PhD. 2018 Jan;34(1):53-58. doi: 10.1097/PEC.0000000000001371. Pediatrics 2014; 133:493. Comparative efficacy of oral dexamethasone versus oral prednisone in acute pediatric asthma. eCollection 2020 Oct. Dong H, Wang T, Wang M, Yan Y, Zhang X, Gu W, Ji W, Huang L, Chen Z. Transl Pediatr. Although multiple small trials exist, clear consensus data are lacking. 2001;139(1):20-26. Bethesda, MD 20894, Copyright Steroids are recommended for moderate to severe asthma exacerbations by the National Asthma Education and Prevention Program. Two reviewers evaluated study quality independently and interrater agreement was assessed. [PubMed 21181954] Rajkumar SV. We give oral dexamethasone as our standard steroid in asthma of all acuity here at Primary Children’s Hospital, for all the reasons Rick so nicely outlines in the article. Epub 2015 Oct 14. See this image and copyright information in PMC. Oral Prednisone for Children With Acute Asthma Exacerbations: A Systematic Review and Meta-Analysis. A search of PubMed (Medline) through October 19, 2013, by using the keywords dexamethasone or decadron and asthma or status asthmaticus identified potential studies. Adherence of pediatric asthma patients with oral corticosteroid prescriptions following pediatric emergency department visit or hospitalization. 2020 Aug 21;1(6):1552-1561. doi: 10.1002/emp2.12224. Enjoying our content? Half-life – Dexamethasone has 4-5 longer 1/2 life than prednisone. Dexamethasone Pharmacodynamics Potency – Dexamethasone is 5-6 times more potent than prednisone. This systematic review and meta-analysis aimed to … … FOIA 2016 May;67(5):593-601.e3. We do not capture any email address. You are working a moderately busy evening shift in the pediatric ED. Patients who received dexamethasone were less likely to experience vomiting in either the emergency department (RR 0.29, 95% CI 0.12–0.69, Q = 3.78, df = 3, I2 = 20.7%) or at home (RR 0.32, 95% CI 0.14–0.74, Q = 2.09, df = 2, I2 = 4.2%). Lee MO, Sivasankar S, Pokrajac N, Smith C, Lumba-Brown A. J Am Coll Emerg Physicians Open. 2020 Jun 8;1(5):955-964. doi: 10.1002/emp2.12103. Dexamethasone for Pediatric Asthma Exacerbations: A Quality Improvement Intervention. 2014;89(6):669]. Several small studies have investigated the utility of oral dexamethasone for acute asthma exacerbations. Data were abstracted by 4 authors and verified by a second author. Randomized trial of single-dose intramuscular dexamethasone compared with prednisolone for children with acute asthma. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. 2014;133(3):493-499. Levine went on to review the pediatric literature—many small studies and a few larger randomized trials—to conclude that a single dose of dexamethasone was probably as good as a course of prednisone for kids in the ED with asthma exacerbations. Although multiple small trials exist, clear consensus data are lacking. You will be redirected to aap.org to login or to create your account. Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis. Thanks for visiting Pulmonology Advisor. The medical student has just finished presenting the kid he saw in bed 8. 1 Emesis of oral prednisolone syrup is not uncommon and may result in hospitalization, a need for intravenous steroids, or suboptimal therapy. Zemek R, Plint A, Osmond MH, et al. CONCLUSIONS: Practitioners should consider single or 2-dose regimens of dexamethasone as a viable alternative to a 5-day course of prednisone/prednisolone. Or Sign In to Email Alerts with your Email Address, Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis, Two regimens of dexamethasone versus prednisolone for acute exacerbations in asthmatic Egyptian children, Outcomes for Pediatric Asthmatic Inpatients After Implementation of an Emergency Department Dexamethasone Treatment Protocol, Dexamethasone versus prednisone for children receiving asthma treatment in the paediatric inpatient population: protocol for a feasibility randomised controlled trial, Dexamethasone promotes durable factor VIII-specific tolerance in hemophilia A mice via thymic mechanisms. Dexamethasone has demonstrated no statistically significant difference in relapse rates (defined as … Background and objective: There have been a number of recent studies that have compared prednisolone to dexamethasone for outpatient treatment of asthma. Reply METHODS: A search of PubMed (Medline) through October 19, 2013, by using the keywords dexamethasone or decadron and asthma or status asthmaticus identified potential studies. There was no difference in relative risk (RR) of relapse between the 2 groups at any time point (5 days RR 0.90, 95% confidence interval [CI] 0.46-1.78, Q = 1.86, df = 3, I2 = 0.0%, 10-14 days RR 1.14, 95% CI 0.77-1.67, Q = 0.84, df = 2, I2 = 0.0%, or 30 days RR 1.20, 95% CI 0.03-56.93). Privacy, Help eCollection 2020 Dec. Int J Environ Res Public Health. Evid Based Med. van de Beek D, de Gans J, McIntyre P, Prasad K. Cochrane Database Syst Rev. Pediatr Emerg Care. If your organization uses OpenAthens, you can log in using your OpenAthens username and password. Pediatrics. Background and objective: Dexamethasone has been proposed as an equivalent therapy to prednisone/prednisolone for acute asthma exacerbations in pediatric patients. doi: 10.1016/j.jpeds.2017.08.030. 2017 Dec;191:190-196.e1. Butler K, Cooper WO. The asthma pathway provides step-by-step guidance for evaluation and treatment of pediatric patients seen in the emergency department for asthma. ALGORITHM FOR ASTHMA MANAGEMENT – EMERGENCY DEPARTMENT . 2 Systemic corticosteroids are the standard of care to treat acute asthma exacerbations. Thank you for your interest in spreading the word on American Academy of Pediatrics. Keeney GE, Gray MP, Morrison AK, et al. Dexamethasone Compared to Prednisone for the Treatment of Children With Acute Asthma Exacerbations. Dexamethasone or prednisolone for asthma exacerbations in children: A cost‐effectiveness analysis. Dexamethasone may be a viable alternative to prednisone/prednisolone for the treatment of acute asthma exacerbation in the paediatric emergency department. Clipboard, Search History, and several other advanced features are temporarily unavailable. This article requires a subscription to view the full text. However, it has a bitter taste that can make it very hard to administer to a young child. Dexamethasone for acute asthma exacerbations in children: a meta-analysis. Methods: March 2018; American Journal of Medical Quality 33(6):106286061876567 Randomized Trial of Dexamethasone Versus Prednisone for Children with Acute Asthma Exacerbations. A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department. Molecules. Objective: Our hospital's pediatric Emergency Department (ED) began using dexamethasone for treating asthma exacerbations after ED studies showed non-inferiority of dexamethasone compared to prednisone.However, providers have not reached consensus on optimal inpatient steroid regimen. One study followed up with … 2002;22:7802–11. Parikh K, Hall M, Mittal V, et al J Pediatr. This study evaluates provider preference for inpatient steroid treatment. Access to this article can also be purchased. 2014 May;4(3):172-80. doi: 10.1542/hpeds.2013-0088. Careers. Injectable dexamethasone given orally may be an effective treatment in pediatric patients who present to the emergency department (ED) with asthma exacerbations, according to a study published in the Journal of Pediatric Pharmacology and Therapeutics.. UL1 TR000055/TR/NCATS NIH HHS/United States, 8UL1TR000055/TR/NCATS NIH HHS/United States. Corticosteroids in acute bacterial meningitis. You’ve viewed {{metering-count}} of {{metering-total}} articles this month. Emergency department treatment of asthma in children: A review. Two reviewers evaluated study quality independently and interrater agreement was assessed. 2020 Nov 13;17(22):8417. doi: 10.3390/ijerph17228417. PRED is also associated with a significant amount of vomiting; this is one of the leading reasons for treatment failure for outpatient asthma.1 Dexamethasone (DEX) has a longer half-life than PRED, is much better tolerated, and has been used for a variety of pediatric conditions, including croup.2,3 A number of recent studies h… Data were abstracted by 4 authors and verified by a second author. This has led many emergency departments to provide a 1-2 dose course of Dexamethasone on discharge. PRED has been the oral steroid used in the treatment of pediatric asthma exacerbations for decades. CAS PubMed PubMed Central Article Google … BACKGROUND AND OBJECTIVE: Dexamethasone has been proposed as an equivalent therapy to prednisone/prednisolone for acute asthma exacerbations in pediatric patients. Although a 5-day course of oral prednisone or prednisolone has become the most commonly used regimen, dexamethasone has also been used for a shorter duration (1–2 days) with potential for improvement in compliance and palatability. Conclusions: National Library of Medicine BACKGROUND AND OBJECTIVE: Dexamethasone has been proposed as an equivalent therapy to prednisone/prednisolone for acute asthma exacerbations in pediatric patients. The disease is characterized by chronic airway inflammation, airway edema, bronchoconstriction, and airway hyperresponsiveness which results in respiratory symptoms like wheezing, shortness of breath, chest tightness, and cough (2). Thus, many inpatients have received a first dose of Dexamethasone … Epub 2014 Jun 10. Dexamethasone May Offer a Better Option. Chen J, Chan WM, Leung HY, Leong PK, Yan CTM, Ko KM. asthma; dexamethasone; prednisolone; prednisone; status asthmaticus. 2014;133(3):493–499 The goal of this meta-analysis was to determine whether intramuscular or oral dexamethasone is equivalent or superior to a 5-day course of prednisone or prednisolone for acute exacerbations of asthma. Check the research. Paniagua N, Lopez R, Muñoz N, Tames M, Mojica E, Arana-Arri E, Mintegi S, Benito J. J Pediatr. RESULTS: There was no difference in relative risk (RR) of relapse between the 2 groups at any time point (5 days RR 0.90, 95% confidence interval [CI] 0.46–1.78, Q = 1.86, df = 3, I2 = 0.0%, 10–14 days RR 1.14, 95% CI 0.77–1.67, Q = 0.84, df = 2, I2 = 0.0%, or 30 days RR 1.20, 95% CI 0.03–56.93). If you have a subscription you may use the login form below to view the article. Oral single dose. Intended for: Children 2 years or older with acute wheeze or cough AND A HISTORY OF: • Asthma OR • Episodic … 2015;167:639-644 Using a decision‐analysis model, we analyzed the cost‐effectiveness of prednisolone vs oral dexamethasone for treating acute pediatric asthma. Intramuscular dexamethasone injections are painful and can be difficult to administer, so oral administration is a preferred route, especially owing to a suggested 80% bioavailability. Dexamethasone efficacy in asthma exacerbation has been studied in the outpatient setting and was found to be as effective as Prednisone. Carlos E. Rodriguez‐Martinez MD, Msc, PhD(c) [PubMed 11445789] Rajkumar SV. Prevention and treatment information (HHS). There have been several randomized controlled trials (RCTs) that have studied dexamethasone vs. prednisone/prednisolone in pediatric asthmatic patients and the overarching message is that dexamethasone is non-inferior in the treatment of pediatric asthma exacerbations. 2020 Aug;9(4):469-479. doi: 10.21037/tp-20-172. The primary outcome of interest was return visits or hospital readmissions. Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health. Practitioners should consider single or 2-dose regimens of dexamethasone as a viable alternative to a 5-day course of prednisone/prednisolone. Along with back-to-back mixed nebulisers, you prescribe oral prednisolone, which he vomits 10 min later. Dexamethasone has been wildly used for a number of pediatric conditions including croup [2], has a longer half-life [3] and is much better tolerated than prednisolone. Comparison of Learning Effects of Virtual Reality Simulation on Nursing Students Caring for Children with Asthma. Front. Dexamethasone has the advantage of shorter course, more compliance, and more tolerable. The objective of this study was to analyze the cost‐effectiveness of prednisolone vs oral dexamethasone for treating pediatric asthma exacerbations. Dexamethasone has been proposed as an equivalent therapy to prednisone/prednisolone for acute asthma exacerbations in pediatric patients. Pediatr Emerg Care. Although multiple small trials exist, clear consensus data are lacking. Pediatr. You may be able to gain access using your login credentials for your institution. Although multiple small trials exist, clear consensus data are lacking. This will require you to. The patient is an 8-year-old boy with known asthma, hereRead More Background: A short course of systemic corticosteroids is an important therapy in the treatment of pediatric asthma exacerbations. Accessibility COVID-19 is an emerging, rapidly evolving situation. Chen Q (2019) Oral Dexamethasone vs. 2020 Sep 4;25(18):4051. doi: 10.3390/molecules25184051. This study will inform a future multi-site trial comparing prednisone/prednisolone to dexamethasone in inpatient asthma treatment. Methods. American Journal of Medical Quality 2018 33: 6, 671-671 Download Citation . doi: 10.1002/14651858.CD004305. A one-time dose of dexamethasone in the ED might be superior to current pediatric asthma management. Dexamethasone causes sustained expression of mitogen-activated protein kinase (MAPK) phosphatase 1 and phosphatase-mediated inhibition of MAPK p38. This systematic review and meta-analysis aimed to determine whether intramuscular or oral dexamethasone is equivalent or superior to a 5-day course of oral prednisone or prednisolone. Pediatrics 2012; 129:671. doi: 10.1016/j.annemergmed.2015.08.001. Enter multiple addresses on separate lines or separate them with commas. He is followed up regularly in a paediatric respiratory clinic and is normally on a preventer inhaler. Is dexamethasone an effective alternative to oral prednisone in the treatment of pediatric asthma exacerbations? A 5-year-old boy presents to the emergency department (ED) with an acute exacerbation of asthma, is assessed as having a tight chest and has an oxygen requirement. It has the potential of improving the delivery of care in asthma, by improving compliance with a mainstay of treatment. Implementation and Improvement of Pediatric Asthma Guideline Improves Hospital-Based Care, Observational study on the palatability and tolerability of oral prednisolone and oral dexamethasone in children in Saudi Arabia and the UK, The Whole "PROOF": Incorporating Evidence-Based Medicine Into Clinical Teaching, Variation in treatment of acute childhood wheeze in emergency departments of the United Kingdom and Ireland: an international survey of clinician practice, Dexamethasone may be a viable alternative to prednisone/prednisolone for the treatment of acute asthma exacerbation in the paediatric emergency department, DOI: https://doi.org/10.1542/peds.2013-2273, To check if your institution is supported, please see, Umbilical Cord Management for Newborns <34 Weeks' Gestation: A Meta-analysis, Childhood and Adolescent Bullying Perpetration and Later Substance Use: A Meta-analysis, Improving Influenza Vaccination in Children With Comorbidities: A Systematic Review, Follow American Academy of Pediatrics on Instagram, Visit American Academy of Pediatrics on Facebook, Follow American Academy of Pediatrics on Twitter, Follow American Academy of Pediatrics on Youtube, Racism and Its Effects on Pediatric Health, Copyright © 2014 by the American Academy of Pediatrics. Mol Cell Biol. In these studies of mild-to-moderate pediatric asthma, IM dexamethasone appears to be as effective as 3 to 5 days of oral prednisone or prednisolone. Triage nurse initiation of corticosteroids in pediatric asthma is associated with improved emergency department efficiency. Asthma is a common pediatric disease that results in significant limitation of activity and an estimated loss of 14.4 million school days in children (1). J Am Coll Emerg Physicians Open. Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis abstract BACKGROUND ANDOBJECTIVE: Dexamethasone has been proposed as an equivalent therapy to prednisone/prednisolone for acute asthma exacerbations in pediatric patients. 12. Six randomized controlled trials in the emergency department of children ≤18 years of age comparing dexamethasone with prednisone/prednisolone for the treatment of acute asthma exacerbations were included. Patients who received dexamethasone were less likely to experience vomiting in either the emergency department (RR 0.29, 95% CI 0.12-0.69, Q = 3.78, df = 3, I2 = 20.7%) or at home (RR 0.32, 95% CI 0.14-0.74, Q = 2.09, df = 2, I2 = 4.2%). Six randomized controlled trials in the emergency department of children ≤18 years of age comparing dexamethasone with prednisone/prednisolone for the treatment of acute asthma exacerbations were included. 2014 Oct;19(5):175. doi: 10.1136/eb-2014-110006. This systematic review and meta-analysis aimed to determine whether intramuscular or oral dexamethasone is equivalent or superior to a 5-day … Would you like email updates of new search results? Cronin JJ, McCoy S, Kennedy U, An Fhailí SN, Wakai A, Hayden J, Crispino G, Barrett MJ, Walsh S, O'Sullivan R. Ann Emerg Med. 2003;(3):CD004405. Pediatric respiratory distress: California out-of-hospital protocols and evidence-based recommendations. Researchers performed a retrospective study of 99 patients aged 0 to 18 years who presented to, and were discharged from, … Keywords: 2004;20(11):730-735. Dexamethasone Dosing Guide for Asthma ** Complete response is defined as oxygen saturations over 90%, no significant increased work of breathing , (PAS less than 7)** CLINICAL PATHWAY . (Survey; 161 patients) Gordon S, Tompkins T, Dayan PS. 2011;86(1):57-65. doi: 10.1002/ajh.21913. Although multiple small trials exist, clear consensus data are lacking. This site needs JavaScript to work properly. J Pediatr. We hope you’re enjoying the latest clinical news, full-length features, case studies, and more. The intensity of the disease varies with time and … Unable to load your collection due to an error, Unable to load your delegates due to an error. Cheng T, Farah J, Aldridge N, Tamir S, Donofrio-Odmann JJ. There was improved perception by parents of their children’s asthma control by better Pediatric Asthma Caregiver’s Quality of Life ... Saklatvala J, Clark AR.

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