Steroids are part of the mainstay of therapy for acute exacerbations of reactive airway disease – but does it matter which steroid we use?
I think it’s clear that answer is: “no”. Multiple studies support using dexamethasone rather than prednisone – best described in pediatrics, but this study reaffirms its utility in adults. The advantage is its half-life of 72 hours, meaning it requires fewer doses and, in theory, greater compliance. Although, really, this study is limited directly as a pharmacologic comparison study specifically because of the compliance issue – there’s no guarantee every patient finished their course of prednisone, while it’s pretty likely patients managed to take at least the 2nd non-placebo dose of their dexamethasone. However, in terms of clinical relevance – it reflects the compliance issues encountered in reality.
There’s an underpowered single-dose dexamethasone pediatric study out there, as well, which appears promising. I like the idea of 100% compliance guaranteed by a single-dose in the ED, but it’s something that needs more data.
Hi there: Great site, and thanks for linking to my site (Acad Life in EM). I just emailed Joel Kravitz, the first author. I asked why they gave such a HUGE dose of decadron at 16 mg. The equivalent to prednisone 60 mg is decadron at 8 mg. He said that it's because some of his faculty give prednisone 100 mg for the daily dose. Not sure if I feel comfortable giving such a high dose of decadron but I'll be sure to consider giving decadron at 8-10 mg for those potentially less compliant with the 5-d prednisone course.
Keep up the great work.
I can't say I've ever seen doses of dexamethasone up to 16mg used, either – 12mg is sort of my maximum standard adult dose, and that's a dose I've used multiple times in consultation with ENT. If you really want to think about preposterously high doses, look at 0.6mg/kg dexamethasone for croup – absolutely unnecessary. Plenty of evidence supporting lower doses, and I have no trouble going as low as 0.15mg/kg and still having literature to cite.