Daniel J. Pallin, MD, MPH reviewing Rehrer MW et al. Ann Emerg Med 2016 Apr 22.

A randomized trial suggests the regimens may be equivalent.

Routine management of asthma exacerbations in emergency department patients includes a 5-day course of prednisone. Dexamethasone has a longer half-life, and prior research has suggested that a 1- or 2-day course of dexamethasone might be as good as a 5-day course of prednisone. Investigators randomized adults with mild-to-moderate acute asthma exacerbations to a single 12-mg dose of oral dexamethasone or 5 days of 60-mg prednisone daily.

Of 465 adult patients randomized, 376 completed the protocol and were analyzed. As assessed by telephone follow-up, relapse occurred in 12.1% of the dexamethasone patients and 9.8% of those on prednisone. The trial was designed as a noninferiority trial, and the upper limit of the 95% confidence interval surrounding the difference of 2.3% (−4.1% to 8.6%) was larger than the prespecified criterion for noninferiority, 8%. Therefore, the authors concluded that the single dose of dexamethasone was not equivalent to the 5-day course of prednisone.

Citation(s):

Rehrer MW et al. A randomized controlled noninferiority trial of single dose of oral dexamethasone versus 5 days of oral prednisone in acute adult asthma. Ann Emerg Med 2016 Apr 22; [e-pub].

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