More children will get just ONE or TWO doses of dexamethasone for asthma exacerbations. We're seeing a shift away from the typical 3- to 5-day course of prednisone or prednisolone to a 1- to 2-day course of dexamethasone.
Dexamethasone is longer acting and may cause less vomiting. Plus new evidence suggests that a SINGLE dose of dexamethasone seems to improve acute asthma symptoms and prevent hospitalization as well as a 3-day course of prednisolone (1 mg/kg per day). In kids with mild to moderate exacerbations, consider using dexamethasone especially if adherence or tolerability is a concern.
- Give 0.3 or 0.6 mg/kg orally once daily for 1 or 2 days, up to a max of 16 mg/dose or as one IM dose.
For kids who can't swallow tabs, recommend crushing and mixing them with chocolate pudding or applesauce to help mask the bitter taste. Or consider dexamethasone 1 mg/mL concentrated solution, but be aware it contains 30% alcohol. Try not to use the 0.5 mg/5 mL liquid due to the large volume. But stick with prednisone or prednisolone if hospitalization is necessary or for kids recently treated for an exacerbation.
References
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Cronin JJ, McCoy S, Kennedy U, An Fhailí SN, Wakai A, Hayden J, Crispino G, Barrett MJ, Walsh S, O'Sullivan R. A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department. Ann Emerg Med. 2016 May;67(5):593-601.e3. Available at: https://www.annemergmed.com/article/S0196-0644(15)01154-3/fulltext
Keeney GE, Gray MP, Morrison AK, Levas MN, Kessler EA, Hill GD, Gorelick MH, Jackson JL. Dexamethasone for acute asthma exacerbations in children: a meta-analysis. Pediatrics. 2014 Mar;133(3):493-9. Available at: https://publications.aap.org/pediatrics/article-abstract/133/3/493/32279/Dexamethasone-for-Acute-Asthma-Exacerbations-in?redirectedFrom=fulltext
Meyer JS, Riese J, Biondi E. Is dexamethasone an effective alternative to oral prednisone in the treatment of pediatric asthma exacerbations? Hosp Pediatr. 2014 May;4(3):172-80. Available at: https://publications.aap.org/hospitalpediatrics/article-abstract/4/3/172/73325/Is-Dexamethasone-an-Effective-Alternative-to-Oral?redirectedFrom=fulltext
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