Efficacy of Single Dose Oral Dexamethasone Over Multidose Prednisolone for Treatment of Acute Asthma Exacerbation in Children

Background: Pediatric acute asthma exacerbations are frequent causes of emergency presentations and common reasons for urgent system corticosteroid treatment. While prednisolone has been the accepted first-line treatment for some time now, single-dose dexamethasone has gained increasing recognition as potentially providing improved compliance and side-effect profiles. However, comparative efficacy at the local levels is under-investigated. Objective: To compare the treatment efficacy of single-dose oral dexamethasone and a three-day course of oral prednisolone in pediatric patients presenting with acute asthma exacerbation. Study Design: Randomized controlled trial. Duration and Place of Study: Conducted from July to December 2024 at the Department of Pediatrics, POF Hospital Wah Cantt. Methodology: A total of 68 children aged 4–12 years, diagnosed with asthma and presenting with PRAM scores ≥6, were enrolled through non-probability consecutive sampling and randomized into two equal groups. Group A received single-dose dexamethasone (0.6 mg/kg, max 12 mg), followed by placebo for two days; Group B received prednisolone (1 mg/kg/day, max 40 mg) for three days. Treatment efficacy was defined as no need for additional systemic steroids at follow-up and >50% improvement in PRAM score. Results: Both groups showed clinical improvement, with Group A exhibiting greater reduction in mean PRAM scores (3.24±0.89 vs. 4.12±0.84). Treatment efficacy was higher in the dexamethasone group (91.2% vs. 79.4%), though the difference was not statistically significant (p=0.305). No significant associations were found with age or gender. Conclusion: Single-dose oral dexamethasone is an effective alternative to multidose prednisolone for acute asthma exacerbations in children, offering comparable outcomes with potentially improved compliance.