Prednisolone is the most commonly prescribed corticosteroid for asthma exacerbations; however, a 5-day course is normally required, and adherence may be an issue. Dexamethasone is a long-acting corticosteroid, and a 1-dose intramuscular or 1- or 2-dose oral course may be an alternative. How do these 2 treatments compare?
A Medline search was performed which revealed 6 randomized trials that have compared the efficacy of prednisolone and dexamethasone for use in pediatric asthma exacerbations.
There was some heterogeneity among the studies, with 3 comparing a single dose of intramuscular dexamethasone with a 3- to 5-day course of oral prednisolone, and 3 comparing 1 or 2 doses of oral dexamethasone with a 5-day course of oral prednisolone. None of the 6 studies reported any significant differences in efficacy for symptom scores, hospitalization rates, or relapse rates.
All 6 studies supported the claim that dexamethasone is just as effective as prednisolone.