Relapse, readmission similar for asthmatic children treated with dexamethasone vs. prednisone
BALTIMORE — Children treated exclusively with dexamethasone or prednisone had similar relapse and readmission rates for asthma, according to findings presented at the Pediatric Academic Societies Meeting.
Researchers conducted a retrospective analysis of 792 patients, aged 2 to 18 years, hospitalized with acute asthma exacerbation at Monroe Carell Jr. Children’s Hospital in Tennessee from January 2012 through March 2015.
“Children who required ICU care, those who received both short-acting steroids (prednisone, prednisolone, and/or methylprednisolone) and long-acting steroids (dexamethasone) while in the hospital, and those who received no systemic steroids were excluded from the study,” David P. Johnson, MD, assistant professor of pediatrics in the division of hospital medicine at Vanderbilt University School of Medicine, told Infectious Diseases in Children. “Also excluded were those in the long-acting steroid group who received a prescription for systemic steroids at discharge.”
Sixty-three percent of patients received only prednisone; the remainder received only dexamethasone, according to the researchers. Statistical evaluation was conducted to compare the length of stay (LOS), 7- and 30-day asthma ED relapse rates and 7-day asthma readmissions between treatment groups.
There were no statistically significant differences in 7-day readmission rates or 7-day and 30-day relapse rates between groups, Johnson said.
“The short-acting steroid group had a statistically significant longer LOS (P = .003) with an increase of 0.17 days (95% CI, 0.059-0.286) after adjusting for severity of illness, age, weight and gender,” study researcher Sara Seghezzo, MD, a second-year resident, told Infectious Diseases in Children. “Children with complex chronic conditions are at higher risk of asthma relapse at 7 and 30 days following discharge independent of other covariates.”
LOS appeared shorter in the dexamethasone-treated group; however, since patients with less-severe episodes were being treated with the drug, the researchers were unable to determine if this was the result of confounding by severity.
“Inpatient administration of dexamethasone is a potentially safe and effective way to treat pediatric asthma patients outside of the ICU setting, and eliminates the barrier of outpatient systemic steroid compliance following discharge,” Seghezzo said. – by Alaina Tedesco
Seghezzo S, et al. Abstract 1488.318. Presented at: Pediatric Academic Societies Meeting; April 30-May 3, 2016; Baltimore.
Disclosure: The researchers report no relevant financial disclosures.