PURPOSE: Compare the efficacy of 3 groups: group I (5 days prednisolone) versus group II (2 day dexamethasone) versus group III (1 day budesonide + 1 day dexamethasone) on improving symptoms and preventing relapse with reduction of hospitalization in children with asthma.
METHODS: A prospective randomized trial of children (2-12 years old) who presented to the Emergency Department at Security Forces Hospital,riyadh,saudi arabia with acute asthma exacerbation from December 1, 2005 to July 30, 2006 was randomized according to their presentation to ED (8:00 AM < 4:00 PM) then (4 PM - < 12 midnight) (12 midnight - < 8 AM) groups will switch each month.All the groups will receive usual asthma treatment and care i.e. oxygentherapy, IVF, salbutamol nebulizer + atrovent.Group I will receive one dose of prednisolone, 2 mg/kg (PO/IV maxm 60 mg in ED) and home dose of prednisolone 1 mg/kg/day PO × 4 days maxm 60 mg.Group II will receive dexamethasone 0.6 mg/kg (PO/IV) maxm 16 mg in ED, same dose nst day at home.Group III budesonide nebulization 0.25 mg/kg Q 30 min × 3 doses and home dose of dexamethasone 0.6 mg/kg. The primary outcome was relapse rate within 10 days.
RESULTS: Relapse Rate (I=30% of67 patient, II=4.76%of 66patient, III=22.5% of67pat) among them hospitalization after relapse (I=10%, II=0, III=4.5%) none were hospitalized from ED, symptoms persistent at 10 days (I=50%, II=19%, III=36.4%) missing school (I=16.6%, II=10%, III=18.18%)Parent compliant with Rx (I=, II=100%) Group III=86.4%, family member advice.
CONCLUSION: Preliminary analysis in children with acute asthma, group II more efficient and has less relapsing and hospitalization rate followed by group III although the compliance rate was poor in this group). Followed with group I.
CLINICAL IMPLICATIONS: Dexamethasone is well known treatment for asthma and shows efficacy in 2 days courses.
DISCLOSURE: amr salama, None.