Oral Dexamethasone to Control Wheezing in Children at an Outpatient Clinic

• Published in: Clinical pediatrics 2019-02, Vol.58 (2), p.151-158
• Main Authors: Volk, Angela S., Marton, Stephanie A., Richardson, Brittany S., Rauda, Luis, Schwarzwald, Heidi L., Naik, Neel M.
• Format: Article
• Language: English
• Subjects: Asthma; Children; Corticosteroids; Dexamethasone; Emergency medical services; Emergency services; Pediatrics; Prednisolone; Prednisone; Steroids; Wheezing
• ISSN: 0009-9228; 1938-2707
• DOI: 10.1177/0009922818809466

Asthma, a chronic childhood disease, has resulted in increased emergency department (ED) visits with high costs. Many asthma ED visits are nonemergent and could be treated in outpatient clinics. Literature has concluded that a 2-day course of oral dexamethasone has comparable outcomes to a 5-day course of prednisone in the ED and hospital setting. A retrospective chart review was performed on children requiring in-house treatment with a corticosteroid (dexamethasone n = 23, prednisone n = 40) for acute asthma exacerbations at an ambulatory medical home. The rates of hospital admissions, ED visits, and symptom follow-up were similar between the 2 groups (P > .05). The cost for a course of dexamethasone was US$1.28 versus US$16.20 for prednisolone. The average cost for an asthma exacerbation office visit was US$79.89 compared with US$3113.28 for an ED visit. A 2-day course of oral dexamethasone appears to be a promising clinical and cost-effective treatment for acute asthma exacerbations at the primary care level.