Intravenous dexamethasone and methylprednisolone treatments for children with critical asthma in the PICU yielded no significant differences in clinical efficacy and safety. Dexamethasone may have potential advantages, such as a shorter corticosteroid exposure duration and less reliance on prescribed corticosteroids at discharge, which merit additional investigation.
Childhood asthma affects approximately 5.1 million children in the United States, with critical asthma cases requiring pediatric intensive care unit (PICU) admission representing around 10% of pediatric asthma hospitalizations. Systemic corticosteroids and nebulized bronchodilators are fundamental in acute management, improving pulmonary resistance and relieving airway obstruction. Methylprednisolone has been the traditional choice for severe exacerbations, but an increasing trend towards using dexamethasone has been observed in PICU settings.
Dexamethasone’s long elimination half-life and potent glucocorticoid activity make it a promising alternative. Studies in emergency departments and general pediatric wards suggest that dexamethasone could reduce inpatient length of stay, hospital relapse rates, gastrointestinal side effects, and direct costs. However, 96% of pediatric intensivists continue to prescribe methylprednisolone based on clinical experience. A study published in the journal Pediatric Pulmonology compared intravenous (IV) dexamethasone and IV methylprednisolone treatments for children with critical asthma in the PICU
Characteristics of the Study Participants
Ninety two participants were enrolled, 61 in the standard care group and 31 in the intervention group. Averaging 9.6 years of age, the participants had a weight-for-age z-score of 0.9 ± 1.2, and were predominantly male (53.3%). The median pediatric asthma severity score at admission was 11 (IQR: 8-12). No significant differences between the trial groups were found in demographics, measurements, asthma severity, or comorbidities, indicating a well-balanced study.
Hospital Stay or Treatment Results Between Standard Care and Intervention Groups
With a median hospital stay of 2.9 days, there was no significant difference between the standard care and intervention groups. Continuous albuterol treatment, administered to 97.8% of participants, showed no notable differences in duration between the groups. The overall exposure rate to combined adjunctive therapy was 62%, with no significant difference between the groups, indicating a well-balanced study.
Asthma Study Shows Safe Treatments With Rare Adverse Events
Throughout the asthma study, no serious adverse events were reported, demonstrating the safety of the treatments. Corticosteroid-related adverse events were rare and showed no discernible differences between participants in the standard care and intervention groups. These events included hyperglycemia (11.5% vs. 6.5%, p = 0.713), hypertension (1.6% vs. 3.2%, p > 0.999), adrenal insufficiency (3.3% vs. 0%, p = 0.538), and altered mentation (3.3% vs. 0%, p = 0.538).
No Gastrointestinal or Respiratory Complications Observed
No instances of gastrointestinal bleeding, gastritis, necrotizing enterocolitis, gastric perforation, or ventilator-associated pneumonia were observed during the study. These findings emphasize the safety of the tested treatments, providing valuable information for future asthma care and research.
Higher Success Rate With Dexamethasone for Asthma Treatment
The study found that using dexamethasone as part of asthma treatment resulted in a higher success rate compared to using methylprednisolone. Participants in the intervention group were given dexamethasone, which allowed more of them to transition to enteral dexamethasone and required fewer prescriptions upon discharge. Both treatment approaches were effective, with no significant differences in the frequency of extended tapers or same-cause hospitalization after discharge observed between the two groups.
Source:
Roddy, M. R., Sellers, A. R., Darville, K. K., Teppa-Sanchez, B., McKinley, S. D., Martin, M., Goldenberg, N. A., Nakagawa, T. A., & Sochet, A. A. (2023). Dexamethasone versus methylprednisolone for critical asthma: A single center, open-label, parallel-group clinical trial. Pediatric Pulmonology. https://doi.org/10.1002/ppul.26386
