Dexamethasone versus prednisone/prednisolone in the management of pediatric patients with acute asthmatic exacerbations: a systematic review and meta-analysis

Abstract

Objective

Acute asthmatic exacerbation is a common condition for pediatric emergency visits. Recently, dexamethasone has increasingly been used as an alternative to prednisone. This study aimed to evaluate the safety and efficacy of dexamethasone (DEX) against prednisone/prednisolone (PRED) in managing pediatric patients with acute asthmatic exacerbation.

Data sources

Cochrane, Embase, PubMed, Scopus, and Web of Science were searched for articles from their inception to August 2022 by two independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) system. The review was registered prospectively with PROSPERO (CRD42022353462).

Study selections

From 316 studies screened, seventeen studies met the eligibility criteria, with 5967 pediatric patients experiencing an asthma exacerbation requiring treatment with either DEX (n = 2865) or PRED (n = 3102). Baseline patient characteristics (age, sex, PRAM (pediatric respiratory assessment measure), previous corticosteroid and beta-agonist inhaler) were comparable between groups.

Results

After treatment administration, the DEX group had fewer vomiting incidents (OR = 0.24, 95% CI: 0.11, 0.51, I² = 58%) and reduced noncompliance events (OR = 0.12, 95% CI: 0.04, 0.34, I² = 0%) when compared to the PRED group. Regarding emergency-department (ED)-related outcomes, there were no differences in hospital admission rates (OR = 0.83, 95% CI: 0.58, 1.19, I² = 15%), time spent in the ED (MD= −0.11 h, 95% CI: −0.52; 0.30, I² = 82%) or relapse occurrences (OR = 0.67, 95% CI: 0.30, 1.49, I² = 52%) between both groups.

Conclusion

Although there were no differences between the DEX and PRED groups in terms of hospital admission rates, time spent in the ED or relapse events, pediatric patients receiving DEX experienced lower noncompliance and vomiting rates.

Keywords:

• Meta-analysis
• dexamethasone
• prednisolone
• prednisone
• asthma
• pediatric

Acknowledgements

We would like to thank Leslie C. Hassett MLS for the literature search.

Authors’ contributions

ED, NG, HN, DS conceived and designed the study, reviewed the literature, collected, analyzed and interpreted the data, drafted and critically reviewed the manuscript. ED, NG, HN, JE, RHM, DT, AB, CAT, and DS reviewed the literature, collected, analyzed, interpreted the data and drafted the manuscript.

Declaration of interest

The authors report no conflicts of interest.

Ethical approval statement

This systematic review and meta-analysis do not require ethical approval.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Data availability statement

With the publication, the data set used for this meta-analysis will be shared upon request from the study authors.