905 Comparison of prednisolone vs dexamethasone in acute asthma and viral induced wheeze

Published Date: 17th August 2022

Publication Authors: Humphreys S, Lisboa L, Chilukuri L

Aims
Early oral corticosteroid therapy is recommended in the treatment of acute asthma exacerbations in children. BTS/SIGN guidelines recommend that children with severe symptoms of viral induced wheeze (VIW) should still receive oral steroids, and that it is advisable in moderately severe cases without a previous diagnosis of asthma. A single dose of dexamethasone has been shown to be non-inferior to a 3- or 5-day course of prednisolone in the management of acute asthma in children and has better tolerability and compliance. Following new local guidelines in 2019, we audited the compliance and outcomes in asthma and VIW treated with prednisolone and dexamethasone.

Methods
A prospective case note audit was performed from 1stNov 2020 - 22ndDec 2020. This was the second winter season following the introduction of the new guideline using dexamethasone to allow time for guideline dissemination and implementation. A retrospective case note audit was performed from 1stNov 2018 - 22ndDec 2018 as a comparison with prednisolone treatment.

All admitted patients aged 0-16 years with a primary diagnosis of asthma or VIW were included. Clinical information was collected from A&E and paediatric wards via the electronic patient record. Readmission was defined as admission under General Paediatrics within 10 days of discharge. Microsoft Excel was used for collating and analysing data.

Results
The total number of patients who met the inclusion criteria was 186: from 1st Nov 2020 - 22ndDec 2020, after the introduction of the new dexamethasone guideline, was 69 and in 2018 was 117. In both cohorts asthma accounted for 26-27% of diagnoses and VIW for the remainder. Baseline demographics including age, sex, diagnosis and regular inhalers were similar in 2018 & 2020 but severity in the 2020 cohort was greater

In 2020 cohort, 53 patients (77%) were given appropriate oral dexamethasone as indicated, and 15 (22%) steroid was incorrectly omitted and 1 (1%) patient was unnecessarily given steroid. When dexamethasone was prescribed 92% of patients had an accurate dose prescribed and 3 (6%) could not be assessed. In the 2018 cohort, 74 patients (64%) were given appropriate oral prednisolone as indicated, and 16 (14%) steroid was incorrectly omitted and 7 (6%) patients were unnecessarily given steroid. 20 (16%) patients appropriately did not receive steroids.

In 2020, the average length of stay was 1.8 days and no patients required readmission. In 2018, the average length of stay was 2.1 days and 6 patients required readmission.

Conclusion

• Although both cohorts were well matched for age, sex and diagnosis, the 2020 prospective cohort had approximately half of the number of attendances, possibly due to the effects of the Covid19 pandemic.
• 99% of patients after the introduction of the new guideline met the criteria for dexamethasone. This is likely due to sampling bias since patients with asthma/VIW who had been discharged by A&E therefore likely to have milder symptoms, were not included.
• Length of stay was shorter, and there were no readmissions in the dexamethasone treated 2020 cohort.

 

McGalliard, R; Humphreys, S; Lisboa, L; Chilukuri, L. (2022). 905 Comparison of prednisolone vs dexamethasone in acute asthma and viral induced wheeze. Archives of Disease in Childhood. 107(Suppl 2), p.A242. [Online]. Available at: https://adc.bmj.com/content/107/Suppl_2/A242.1 [Accessed 22 December 2022]

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