Shannan Eades, Jessica Hoover February 02, 2017

To compare efficacy and safety outcomes between children receiving a two-dose regimen of dexamethasone and children receiving a multidose regimen of oral prednisone/prednisolone for the treatment of acute asthma exacerbations not requiring admission to the intensive care unit.

1. To determine if Asthma Assessment Scores differ between groups.
2. To determine if use of adjunctive medications, length of stay, transfer to the intensive care unit, and 7- and 30-day hospital readmission rate differ between groups.
3. To determine if gastrointestinal tolerance after corticosteroid administration differs between groups.

• Patients 4-17 years of age
• Hospitalized for an acute asthma exacerbation
  • ICD-9-CM code: 493.92
  • ICD-10-CM code: J45.901
• Received therapy with either dexamethasone or prednisone/prednisolone
• Admitted to Children’s Memorial Hermann Hospital
• Admitted between January 1, 2014 to September 30, 2016

• Pregnant
• Required initial management in the intensive care unit
• Received corticosteroid therapy due to a secondary diagnosis (e.g., croup or anaphylactic shock)
• Received therapy with both dexamethasone and prednisone/prednisiolone
• Received therapy with racemic epinephrine

1. Clinical characteristics: age, gender, weight, height, asthma severity (intermittent, mild persistent, moderate persistent, severe persistent)

2. Admit diagnosis

3. Length of hospitalization

4. Asthma Assessment Score

5. Medication

   1. Dexamethasone dose (mg), duration of therapy, dosing interval (days and hours)
   2. Prednisone/prednisolone/methylprednisolone dose (mg), number of doses, duration of therapy, dosing interval (days and hours)
   3. Total albuterol (mg), ipratropium (mg), magnesium (mg), terbutaline (mg)

6. 7- and 30-day hospital readmission

7. Transfer to the ICU during admission

8. Episodes of nausea/vomiting after corticosteroid administration

The main outcome measured will be Asthma Assessment Score.

Additional outcomes measured will be use of adjunctive medications for asthma exacerbation, length of hospitalization, 7- and 30-day hospital readmission, and transfer to an ICU after admission.