CLINICAL QUESTION: How does dexamethasone compare to prednisone or prednisolone when used to treat pediatric asthma exacerbations?
BACKGROUND: Historically, the standard of care steroid choice for treating pediatric asthma exacerbations has been prednisone or prednisolone. However, systematic reviews, meta-analyses, and clinical practice have shown that dexamethasone and prednisone or prednisolone have a comparable effect in asthma exacerbation management. This study aimed to serve as an updated and more scientifically rigorous meta-analysis comparing the efficacy of these two types of glucocorticoids in pediatric asthma exacerbations.
STUDY DESIGN: Systematic review and meta-analysis
SETTING: A meta-analysis of 16 randomized controlled trials done globally before March 2025
SYNOPSIS: This meta-analysis included 16 studies with a total of 2,917 individuals (1,481 individuals treated with dexamethasone and 1,436 individuals treated with prednisone or prednisolone) that showed no significant difference in risk of hospitalization (relative risk [RR], 0.96; 95% confidence interval [CI], 0.79 to 1.17), intensive care admission (RR, 0.64; 95% CI, 0.08 to 4.88), relapse of symptoms (RR, 0.99; 95% CI, 0.71 to 1.38), hospital readmission (RR, 0.90; 95% CI, 0.34 to 2.35), pediatric respiratory assessment measure scores (RR, -0.24; 95% CI, -0.54 to 0.06), length of hospital stay (RR, -2.96; 95% CI, -6.91 to 1.53), and risk of noncompliance (RR, 0.47; 95% CI, 0.07 to 3.01) when using dexamethasone compared to prednisone or prednisolone in treatment of pediatric asthma exacerbations. Individuals treated with dexamethasone were at a significantly lower risk of vomiting (RR, 0.39; 95% CI, 0.25 to 0.59). Some studies used in this meta-analysis did not include all the reported outcomes, were at risk for high bias, and were methodologically different. The average age of patients in the studies ranged from 3 to 7.5 years old, so results may not apply to younger patients.
BOTTOM LINE: Dexamethasone is an effective alternative to prednisone or prednisolone for the treatment of pediatric asthma exacerbations.
CITATION: Wang H, et al. The efficacy of dexamethasone compared to prednisone/ prednisolone for the management of pediatric patients with acute exacerbation of asthma: a systematic review and meta-analysis. J Asthma. 2025;62(11):1831-1842. doi: 10.1080/02770903.2025.2526376.
Dr. Gupta
Dr. Gupta is a pediatric hospital medicine fellow at Nationwide Children’s Hospital in Columbus, Ohio.
Dr. Binder
Dr. Binder is a pediatric hospitalist in the department of hospital medicine at Nationwide Children’s Hospital and an assistant professor of medicine at The Ohio State University College of Medicine, both in Columbus, Ohio.
