Dexamethasone for asthma in the ER: Better compliance, nearly equal effectiveness

"Any time we can reduce the role of patient compliance with asthma, we have a chance of improving outcomes," said lead study author Matthew W. Rehrer, MD, of the Department of Emergency Medicine with Kaiser Permanente in Oakland, Calif. "Dexamethasone allows the emergency physician to administer treatment in one dose and doesn't rely on the patient to remember to take her pills for four more days after leaving the ER. A single dose of medication eliminates prescription adherence barriers such as forgetfulness, cost and dose omission."

Adult patients with mild to moderate asthma who came to the emergency department were randomly assigned to one of two groups: a single dose of dexamethasone with 4 days of placebo to be taken at home or a 5-day course of oral prednisone. Relapse was defined as an unscheduled return visit to a health care provider for additional treatment for persistent or worsening asthma within 14 days.

Of patients assigned to the dexamethasone group, 12.1 percent relapsed. Of patients assigned to the prednisone group, 9.8 percent relapsed. Rates of hospitalization were about the same: 3.4 percent for dexamethasone and 2.9 percent for prednisone.

"In my personal experience as an emergency physician, I had many asthmatic patients relapsing because they were unable to fill their prednisone prescriptions," said Dr. Rehrer. "For those patients and others like them, I might prefer to administer dexamethasone because it eliminates for them the burden of having to fill the prescription and remember to take it for the next four days. When it comes to patient compliance, convenience counts."