Oral prednisolone or dexamethasone, which one to be prefered for preventing relapse of acute asthma exacerbations in childhood?

In this prospective, randomized, clinical trial, 68 asthmatic patients, between 6 and 12 years were followed-up for 2 weeks after their acute exacerbation had been stabilized by the standard acute asthma treatment protocol. They were assigned to receive either 2 mg / kg / day of prednisolone divided on 3 doses for 5 days [PRED group], or 0.5 mg / kg / day of dexamethasone as a single morning dose for 3 days [DEX group]. The primary outcome measure was the rate of relapse within the follow-up period assessed by a Peak Expiratory Flow Rate [PEFR] < 70% of the predicted value, and a clinical asthma severity score more than 3. The secondary outcome measures included persistence of symptoms, quality of life, medication use, and adverse effects. There was no significant difference in relapse rates between the two groups [13.3% For PRED group and 15.2% for DEX group, P= 0.87].Compliance to medication was significantly higher in DEX group compared with PRED group[P= 0.04], and more children vomited their medication in the PRED group than in DEX group, but the difference was non-significant [P=0.32]. There was no significant difference between the two groups in the prevalence of persistent symptoms, quality of life, or adverse effects other than vomiting at the time of follow - up [P< 0.05]. We concluded that dexamethasone was as effective as prednisolone, with better compliance and less adverse effects, for preventing relapse of acute asthma exacerbations in childhood

Risk of adrenal suppression and posterior subcapstilar cataract in asthmatic children on inhaled corticosteroids

To investigate some of the expected side effects of corticosteroid therapy, 20 asthmatic children on low dose Belcomethasone dipropionate [BDP] [<400 micro g / day] and another 20 asthmatic children on high dose BDP [= or > 400 micro g / day] were enrolled in this study. They have been compared with 20 asthmatic children who have never been treated with inhaled corticosteroids. Only high doses of inhaled corticosteroids caused significant reduction of 24 hours urinary cortisol excretion. [P<0.01]. Asthmatic children who used BDP directly through Metered Jose inhaler [MDI] showed more suppression of the adrenal function than those who received it by spacers. Posterior subcapsular cataract [PSC] was not detected in any of the patients