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.