Steroids In The Management Of Acute Asthma Exacerbations In Children, Which Form Is More Suitable?
Steroids In The Management Of Acute Asthma Exacerbations In Children, Which Form Is More Suitable?
The aim of this study is to compare the efficacy of a single dose of intramuscular
 dexamethasone versus 3 days of twice-daily oral prednisolone in the management of mild to
 moderate asthma exacerbations in children and test whether this single dose of intramuscular
 dexamethasone 0.6 mg/kg (max. 18 mg) is equal to prednisolone 1 mg/kg/day (max. 40 mg) in the
 treatment of exacerbations of asthma in children, as measured by the Pediatric Respiratory
 Assessment Measure (PRAM).
This study will be performed in Assiut university Children Hospital and will include patients
 with asthma exacerbations presented to the emergency department for three months. All
 children presenting to the emergency department with mild to moderate asthma exacerbations
 will be assessed to decide if the child needs treatment with salbutamol. Before starting
 treatment the Pediatric Respiratory Assessment Measure (PRAM), vital signs, and oxygen
 saturation will be recorded. Peak expiratory flow rate (PEFR) will also be recorded if the
 patient was 6 years or older.

 Children with mild to moderate asthma exacerbation will be given the first dose of salbutamol
 and will be reassessed after 20 min by the emergency department attending. If further
 salbutamol is needed, subjects automatically will receive the second dose 20 min apart and
 receive either single dose of intramuscular dexamethasone (0.6 mg/kg to a maximum of 18 mg)
 or oral prednisolone for 3 days (1 mg/kg to a maximum of 40 mg), given orally .

 A repeat physical examination will be performed, including oxygen saturation, vital signs,
 PRAM, PEFR after the 3rd dose of salbutamol and at the end of the third day to evaluate the
 effect of prednisolone and dexamethasone on the improvement of asthma scores. Patient
 compliance to prednisolone therapy for three days will be also recorded.

 This study will be performed in Pediatric hospital - Assiut university and will include
 patients with asthma exacerbations presented to the emergency department for three months.
Inclusion Criteria:

 -  Ages 2 to 16 years

 -  Background history of asthma

 -  Presentation with an asthma exacerbation requiring repeated salbutamol after 20
 minutes.

 Exclusion Criteria:

 -  Less than 2 years old or over 16 years

 -  Critical or life-threatening asthma

 -  Known tuberculosis exposure

 -  Active varicella or herpes simplex infection

 -  Documented concurrent infection with Respiratory syncytial virus

 -  Fever >39.5°C

 -  Use of oral corticosteroids in the previous four weeks

 -  Concurrent stridor

 -  Significant co-morbid disease: lung, cardiac, immune, liver, endocrine, neurological
 or psychiatric