Can Low-Dose Dexamethasone Be Used Instead Of Prednisolone In Acute Asthma Attacks?

A girl aged 5 years presents to the paediatric A\u0026E department with an asthma attack requiring oral steroids. Following inhaled salbutamol therapy, she keeps spitting out or vomiting the oral prednisolone despite repeat attempts of administration. The senior house officer asks about using dexamethasone, which is also an oral steroid preparation and when used in croup it is well tolerated by children. However, for her weight the dose of 0.6 mg/kg exceeds the recommended prednisolone equivalent. You consider whether a low dose of dexamethasone could be used successfully for an acute asthma attack.\n\nIn children presenting with an asthma or wheeze attack requiring steroids (population), is a single dose of 0.3mg/kg oral dexamethasone (intervention) inferior to oral prednisolone (comparison) in time to discharge from emergency department, admission rates, length of hospital admission, escalation of management and hospital re-attendance (outcome)?\n\nMedline (1946–19 May 2020) and Embase (1980–2020 week 20) using the search terms ((*steroid OR dexamethasone OR prednisolone) AND (asthma exacerbation OR acute asthma …