Friday, August 12, 2016

Dexamethasone for Adult Asthmatics

R.E.B.E.L.EM - Posted by Anand Swaminathan - August 11, 2016
"Background: Acute asthma presentations account for more than 2.1 million Emergency Department (ED) visits annually. In the US, 8.4% of the population is affected by the disease. Current guidelines from the National Heart, Lung, and Blood Institute recommend a minimum of 5 days of oral prednisone to treat moderate to severe asthma exacerbations (NHLBI Guidelines 2007). Oral and parenteral dexamethasone have similar bioavailability, with a duration of action of 72 hours. There has been promising data on dexamethasone for acute asthma from the pediatric literature, as well as a 2-dose regimen in adults. However, due to the strong association with low patient adherence and poor outcomes, a single dose of a long acting oral medication in the ED may help prevent relapse of symptoms...
Author’s Conclusions: “A single dose of oral dexamethasone did not demonstrate noninferiority to prednisone for 5 days by a very small margin for treatment of adults with mild to moderate asthma exacerbations. Enhanced compliance and convenience may support the use of dexamethasone regardless”
Our Conclusions: The frequency of relapse was slightly higher with dexamethasone than prednisone (12.1% versus 9.8%),with an absolute difference was only 2.3%. Although this point estimate is below the preset upper limit for noninferiority, the upper limit of the confidence interval slightly exceeds the 8% difference set by the authors. As a result, this study does not establish noninferiority of single dose dexamethasone. However, due to issues of patient compliance with treatment regimens, a single dose of 12mg of dexamethasone by mouth seems like a reasonable alternative to a 5-day course of prednisone for adults with acute asthma exacerbations. A larger, multicenter trial investigating this intervention should be undertaken.
Potential Impact to Current Practice: The results of this study suggest that oral dexamethasone 12mg is either similar to or slightly inferior to a 5-day course of prednisone 60mg for adult patients with acute asthma exacerbations in the ED.
Clinical Bottom Line: A single dose of oral dexamethasone 12mg may be a reasonable alternative to a 5-day course of prednisone 60mg for adults with asthma exacerbations."