Dexamethasone may offer pediatric asthma alternative

Dexamethasone may be an adequate replacement for prednisone or prednisolone in treating pediatric asthma exacerbations, offering patients a shorter course of treatment with fewer side effects and increased compliance, according to a new report.

"There are several emergency department papers that found dexamethasone equally as effective as prednisone," says Kavita Parikh, MD, MSHS, lead author of the report, published in the Journal of Pediatrics. "There is a benefit for clinical practice in that it offers a more patient-centered approach."

Asthma exacerbations are the second most common reason for pediatric hospital admissions, with more than 137,000 admissions related to asthma in 2009 alone, according to the report.

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These exacerbations are typically treated on an inpatient basis with prednisolone or prednisone, a short-acting corticosteroid that is often administered in the form of an oral tablet or syrup in pediatric patients. However, long-term side effects include vomiting and its bitter taste may reduce patient compliance with a full course of treatment.

Dexamethasone is a long-acting corticosteroid option that can be administered as a full course of one dose or two doses over two days but has the same effect as a five-day course of prednisone or prednisolone, the study notes.

Additionally, the study indicates that dexamethasone may be better absorbed than prednisone or prednisolone.

"Dexamethasone has a greater affinity for the glucocorticoid receptor compared with methylprednisolone, prednisolone, or prednisone, and is five times more potent when receptor affinity and pharmacokinetics are considered together," the study notes. "Dexamethasone is also well-absorbed by both oral and intramuscular routes of administration."

 

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