Swapping Out Asthma Attack Meds

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Dexamethasone for asthma attacks may be alternative for prednisone

February 12, 2014 / Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

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(dailyRx News) When a child has an asthma attack requiring a visit to the hospital, it's common to prescribe them prednisone. But there may be a good alternative.

A recent study found that giving children a medication called dexamethasone instead might lead to less side effects such as vomiting.

Children also required only one or two doses of dexamethasone, compared to five days of prednisone medication.

The brand names for dexmathasone include Decadron, Baycadron and Dexamethasone Intensol.

"Ask your child's pediatrician about dexamethasone for asthma attacks."

This study, led by Grant E. Keeney, MD, of the Department of Pediatrics at Medical College of Wisconsin in Milwaukee, looked at the effectiveness of using dexamethasone to treat severe asthma attacks in children.

More commonly, severe asthma attacks are treated with prednisone.

The researchers searched for all the articles that compared using dexamethasone to using prednisone in children to treat asthma attacks.

Only six randomized, controlled medical trials were identified that compared these two medications for children under age 18 having an asthma attack.

Dexamethasone is given as a single dose or as two doses, whereas the prednisone is given in a five-day course.

The researchers did not find that children relapsed any more quickly in one group than in the other, including at five days after treatment and at two weeks and one month after treatment.

The children who received dexamethasone, however, were a little less likely to vomit (both at the hospital and at home) than children who took prednisone.

The researchers therefore concluded, "Practitioners should consider single or 2-dose regimens of dexamethasone as a viable alternative to a 5-day course of prednisone/prednisolone."

According to Chris Galloway, MD, a dailyRx expert who specializes in emergency medicine, asthma attacks are a common reason that children visit the ER.

"Acute visits are distressing to the parents and sometimes the ER staff, but fortunately readily available and effective treatments exist," Dr. Galloway said. "Once we get these kids over the acute phase, they are often sent home with a prescription for corticosteroids (liquid or pill) which reduce inflammation and hopefully prevent relapse."

This study shows that the corticosteroid dexamethasone, which is already commonly used for pediatric croup, can be as effective as prednisone for asthma attacks.

"The benefit is that a single dose can be effective at preventing relapse in most cases, which mitigates concern for compliance and minimizes the parental frustration of trying to get their kids to take medications everyday for five days," Dr. Galloway said.

This study was published February 10 in the journal Pediatrics. The research was funded by the National Center for Advancing Translational Sciences and the National Institutes of Health. The authors reported no conflicts of interest.