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Outcomes of a dexamethasone-prednisone combination treatment course for status asthmaticus. J Asthma 2024 Dec;61(12):1646-1654

Date

06/24/2024

Pubmed ID

38913839

DOI

10.1080/02770903.2024.2372604

Scopus ID

2-s2.0-85197657334 (requires institutional sign-in at Scopus site)

Abstract

OBJECTIVES: Dexamethasone has become the standard of care for pediatric patients with status asthmaticus in the emergency department (ED) setting. Inpatient providers often must decide between continuing the second dose of dexamethasone or transitioning to prednisone. The effectiveness of receiving dexamethasone followed by prednisone (combination therapy) compared to only prednisone or dexamethasone remains unclear. This study compares patient characteristics and ED reutilization/hospital readmission outcomes of dexamethasone, prednisone, and combination therapy for inpatient asthma management.

METHODS: A retrospective study was conducted at our tertiary children's hospital of children aged 2 to 18 years hospitalized between March 2016 and December 2018 with a primary discharge diagnosis of asthma, reactive airway disease, or bronchospasm. The differences between steroid groups were compared using Fisher's exact or Chi-square tests for categorical variables, and a Kruskal-Wallis test for continuous variables. A multivariable logistic regression was performed to analyze ED reutilization and hospital readmission rates.

RESULTS: 1697 subjects met inclusion criteria. 115 (6.8%) patients received dexamethasone, 597 (35.2%) received prednisone, and 985 (58.0%) received combination therapy. Patients prescribed combination therapy had a lower exacerbation severity than patients prescribed prednisone, but higher severity than patients prescribed dexamethasone (p < .001, p = .001, respectively). Dexamethasone and combination therapy were not associated with increased 30-day ED reutilization/hospital readmissions compared to prednisone (p > .05).

CONCLUSIONS: In our study, most patients hospitalized for status asthmaticus received combination therapy. Despite the differences in severity between steroid groups, outcomes of combination therapy and dexamethasone monotherapy, as measured by frequency of ED reutilizations/hospital readmissions, are comparable to prednisone monotherapy.

Author List

Nelipovich S, Vepraskas SH, Soung P, Pronko K, Yan K, Zhang L, Porada K, Chou E

Authors

Paula Soung MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Sarah Vepraskas MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Ke Yan PhD Associate Professor in the Pediatrics department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Dexamethasone
Drug Therapy, Combination
Emergency Service, Hospital
Female
Glucocorticoids
Humans
Male
Patient Readmission
Prednisone
Retrospective Studies
Status Asthmaticus
Treatment Outcome