Why dexamethasone in acute asthma exacerbation used for 1 or 2 day only while prednisolone used for 3 to 7 day
This difference is related to the difference of Pharmacokinetics between Dexamethasone and predinsolone ,as Dexamethasone has the longer half life.
Because dexamethasone has a long half-life, Altamimi et al attempted to determine if a single dose of dexamethasone (0.6 mg/kg) was equal to 5 days of prednisolone (2 mg/kg daily). The single dose of dexamethasone demonstrated no difference in any of the following: hospital admission rates (13.4% dexamethasone vs 14.9% prednisolone), additional β-agonist therapy, return to baseline of patient self-assessment scores (5.21 days vs 5.22 days, respectively, mean difference −0.01; 95% CI −0.70 to 0.68), and mean pulmonary index scores (0.4 vs 0.3, mean difference 0.1; 95% CI −0.25 to 0.45) in children 2 to 16 years of age with mild to moderate asthma.
Reference:
Use of dexamethasone and prednisone in acute asthma exacerbations in pediatric patients
PMCID: PMC2718595
PMID: 19602654
Dexa preferred as 1st choice for longer half life, oral form preferred than iv
Systemic corticosteroids have the potential to cause severe adverse effects (e.g., gastrointestinal bleeding, sepsis, pneumonia, and adrenal suppression), with systemic adverse effects more common with parenteral or long-acting corticosteroids.
Typically treat for 3 days and then review. Parenteral corticosteroids required for severe and life-threatening exacerbations can be given for up to 10 days with regular review.
And this applies for both Dexamethasone and Prednisolone, however prednisolone is the first choice due to the limited data available for Dexamethasone in asthma.
Ref: GINA 2023, BTS/SIGN 2019
