Dexamethasone Versus Prednisone In The Treatment Of Acute Asthma In Adults: Can An Easier Regimen Provide The Same Results?

RATIONALE: This study is being performed to analyze the revisit rate of patients treated in the Emergency Department for acute asthma exacerbation with, and subsequently discharged home on, prednisone versus those patients who were treated with dexamethasone. METHODS: A prospective study is being performed on patients who present to the Emergency Department with acute asthma exacerbation. After receiving consent for participation. Patients were randomized to one of two study arms. Both arms received the same medical/pharmacologic interventions, however, patients in the one arm received Prednisone 40mg while patients in the opposing arm received Dexamethasone 16mg. Stabilized patients, deemed not requiring hospitalization, were sent home as follows. Those who received Prednisone in the ED continued Prednisone 40mg to complete 5 days of therapy, while those who received Dexamethasone received Dexamethasone 16mg for one additional day; patients from both arms of the study were supplied with their respective medications. Thereafter, patients were contacted on Day 5, Day 10, and Day 30 for a follow-up in the form of a questionairre. This study is still ongoing. RESULTS: A total of 58 patients have been enrolled in the study to date. Follow-up questionairres were obtained on Day 5, Day 10, and Day 30. Revisit rates were shown to be higher for those in the Dexamethasone treatment arm based on Day 5 questionairre results, however, were lower in the Dexamethsone arm based on Day 10 and Day 30 results (19% versus 33.3%; 95% confidence interval 0.64 to 3.32; p=0.46 ). In regards to symptom resolution, defined as patients return to baseline or no limitation in daily activities, a higher percentage of individuals reported symptom resolution in the Prednisone treatment group, however, these results were not statistically significant. Finally, overall therapy compliance was similar among both treatment groups. CONCLUSION: Our results to date indicate that 2 days of dexamethasone therapy is at least as effective as 5 days of prednisone therapy in the treatment of acute asthma exacerbation not requiring hospital admission. Relapse rates and symptom improvement were found to be similar amongst both groups, as were medication compliance. Continued enrollment and follow-up will provide for more insight/data regarding therapy choice. In addition, the choice of dexamethasone over prednisone secondary to medication compliance, cost savings, and resolution/improvement of acute symptomatology is potentially justified, however, if the patient is not cognizant, recurrent exacerbation will occur regardless of which systemic corticosteroid is chosen.