• R J Scarfone, J M Loiselle, J F Wiley, J M Decker, F M Henretig, and M D Joffe.
• Department of Pediatrics, Temple University School of Medicine, St Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.
• Ann Emerg Med. 1995 Oct 1; 26 (4): 480-6.

Study ObjectiveTo compare nebulized dexamethasone with oral prednisone in the treatment of children with asthma.DesignA randomized, double-blind, double-placebo study.SettingAn urban pediatric emergency department.ParticipantsPatients aged 1 to 17 years with acute asthma.InterventionsPatients with moderate asthma exacerbation received frequent aerosolized albuterol and either 1.5 mg/kg of nebulized dexamethasone or 2 mg/kg of oral prednisone.ResultsA total of 111 children was evaluated; 21% of those treated with dexamethasone required hospitalization, compared with 31% of those treated with prednisone (P = .26). A significantly greater proportion of dexamethasone-treated children were discharged home within 2 hours (23% versus 7%, P = .02). In the dexamethasone group, 8% who received the drug by mouthpiece were hospitalized compared with 33% who received it by face mask (P = .06). Fewer children treated with dexamethasone vomited (0% versus 15%, P = .001) and fewer relapsed within 48 hours of ED discharge (0% versus 16%, P = .008).ConclusionNebulized dexamethasone was as effective as oral prednisone in the ED treatment of moderately ill children with acute asthma and was associated with more rapid clinical improvement, more reliable drug delivery, and fewer relapses.

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