Is one dose of PO dexamethasone enough or do you need to send your adult asthmatic patient home on a 5 day oral prednisone course?

A noninferiority study published in Annals of Emergency Medicine in 2016 says maybe it doesn’t matter.

What was the study? Adult ED patients ages 18-55 were randomized to receive either a single dose of 12mg PO dex with 4 days of placebo or a 5-day course of PO pred 60mg/day.  They studied relapse by a follow-up telephone interview at 2 weeks.

What were the results?

Dex group 173 patients

Pred group 203 patients

Subjects in the 2 groups had similar rates of hospitalization and adverse effects and PO dex was noninferior to prednisone x 5 days.  And of course it’s easier to comply with one dose of a medication vs 5 days of medication.

 

Rehrer, M et al.  A Randomized Controlled Noninferiority Trial of Single Dose of Oral Dexamethasone Versus 5 Days of Oral Prednisone in Acute Adult Asthma. Annals of Emergency Medicine. November 2016: 68(5):608-613.

PS: Nachi is the “senior scrub fashionista” and was the one to arrange our FIGS scrubs so thank him next time you see him! 

PPS: Quinoa picture is back by popular demand