EBQ:Single Dose Dexamethasone in Asthma - Revision history

Ostermayer: Text replacement - "Category:Peds" to "Category:Pediatrics"

2016-03-22T15:59:53Z

Text replacement - "Category:Peds" to "Category:Pediatrics"

← Older revision		Revision as of 15:59, 22 March 2016
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	[[Category:~~Peds~~]]		[[Category:Pediatrics]]

Catierey: status complete

2015-09-24T15:45:33Z

status complete

← Older revision		Revision as of 15:45, 24 September 2015
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	\| fulltexturl= http://journals.lww.com/pec-online/Abstract/2006/12000/Single_Dose_Oral_Dexamethasone_in_the_Emergency.3.aspx		\| fulltexturl= http://journals.lww.com/pec-online/Abstract/2006/12000/Single_Dose_Oral_Dexamethasone_in_the_Emergency.3.aspx
	\| pdfurl= http://www.infomine.com/publications/docs/asthmapaper.pdf		\| pdfurl= http://www.infomine.com/publications/docs/asthmapaper.pdf
	\| status=~~Under Review~~		\| status=Complete
	}}		}}
	==Clinical Question==		==Clinical Question==
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	==Major Points==		==Major Points==
	*Mean number of days needed for Patient Self Assessment Score to return to baseline (0–0.5) in the Dex and Pred groups were 5.21		*Mean number of days needed for Patient Self Assessment Score to return to baseline (0–0.5) in the Dex and Pred groups were 5.21 vs. 5.22 days.
	~~versus~~ 5.22 days.
	*Pulmonary index scores were similar in both groups at initial presentation, initial ED discharge and at the day 5 follow-up visit.		*Pulmonary index scores were similar in both groups at initial presentation, initial ED discharge and at the day 5 follow-up visit.
	*~~At the first visit, mean time to discharge was 3~~.~~5 h (±1.93) for Dex and~~ 4~~.3 h (±3.67) for Pred~~		*Overall hospital admission rates were 13.4% (Dex) vs. 14.9% (Pred)
	*Initial admission rate was 9% (Dex) ~~versus 13~~.4% (Pred).
	*There was no significant difference in the number of salbutamol therapies needed in the ED nor at home after discharge.		*There was no significant difference in the number of salbutamol therapies needed in the ED nor at home after discharge.
	*For subjects discharged home, the admission rate after initial discharge was 4.9% (Dex) versus 1.8% (Pred), resulting in overall hospital admission rates of 13.4% (Dex) and 14.9% (Pred)

	==Study Design==		==Study Design==
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	===Primary Outcome===		===Primary Outcome===
	*Primary outcome was number of days needed for Patient Self Assessment Score to return to baseline (score of 0-0.5)		*Primary outcome was number of days needed for Patient Self Assessment Score (seen in table below) to return to baseline (score of 0-0.5)
	**Mean was 5.21 vs. 5.22 days (Dex vs. Pred)		**Mean was 5.21 vs. 5.22 days (Dex vs. Pred)

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	===Subgroup analysis===		===Subgroup analysis===



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	*PEFR is a more valid and reproducible measurement, but was performed in a minority of patients		*PEFR is a more valid and reproducible measurement, but was performed in a minority of patients
	**Can only be measured in kids older than 6 years, and in patients who are able to perform the test		**Can only be measured in kids older than 6 years, and in patients who are able to perform the test
	*No differentiation made between moderate and severe exacerbations so fine treatment differences cannot be determined		*No differentiation made between moderate and severe exacerbations, so fine treatment differences cannot be determined
	*Only patients with mild and moderate asthma exacerbations were included in the study so conclusions cannot be extrapolated to patients with severe asthma		*Only patients with mild and moderate asthma exacerbations were included in the study, so conclusions cannot be extrapolated to patients with severe asthma
	*In another study ED based study, a 2 day dosing of dexamethasone in adults (18-45 yo) was found to be at least effective as 5 days of oral prednisone in preventing relapse and resolving the exacerbation.		*In another study ED based study, a 2 day dosing of dexamethasone in adults (18-45 yo) was found to be at least effective as 5 days of oral prednisone in preventing relapse and resolving the exacerbation.
	*A meta-analysis in 2014 found no difference in relative risk of relapse between children (≤18) treated with dexamethasone (1 or 2 dose regimens) compared to 5 day oral prednisone<ref>Keeney GE et al. Dexamethasone for acute asthma exacerbations in children: a meta-analysis. Pediatrics. 2014 Mar;133(3):493-9.</ref>		*A meta-analysis in 2014 found no difference in relative risk of relapse between children (≤18) treated with dexamethasone (1 or 2 dose regimens) compared to 5 day oral prednisone<ref>Keeney GE et al. Dexamethasone for acute asthma exacerbations in children: a meta-analysis. Pediatrics. 2014 Mar;133(3):493-9.</ref>

Catierey: funding

2015-09-24T15:40:47Z

funding

← Older revision		Revision as of 15:40, 24 September 2015
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	==Funding==		==Funding==
			*Peak flow meters provided by Trudell Medical

	==Sources==		==Sources==

Ostermayer: /* Criticisms & Further Discussion */

2015-09-23T11:56:11Z

Criticisms & Further Discussion

← Older revision		Revision as of 11:56, 23 September 2015
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	*No differentiation made between moderate and severe exacerbations so fine treatment differences cannot be determined		*No differentiation made between moderate and severe exacerbations so fine treatment differences cannot be determined
	*Only patients with mild and moderate asthma exacerbations were included in the study so conclusions cannot be extrapolated to patients with severe asthma		*Only patients with mild and moderate asthma exacerbations were included in the study so conclusions cannot be extrapolated to patients with severe asthma
			*In another study ED based study, a 2 day dosing of dexamethasone in adults (18-45 yo) was found to be at least effective as 5 days of oral prednisone in preventing relapse and resolving the exacerbation.
	*A meta-analysis in 2014 found no difference in relative risk of relapse between children (≤18) treated with dexamethasone (1 or 2 dose regimens) compared to 5 day oral prednisone<ref>Keeney GE et al. Dexamethasone for acute asthma exacerbations in children: a meta-analysis. Pediatrics. 2014 Mar;133(3):493-9.</ref>		*A meta-analysis in 2014 found no difference in relative risk of relapse between children (≤18) treated with dexamethasone (1 or 2 dose regimens) compared to 5 day oral prednisone<ref>Keeney GE et al. Dexamethasone for acute asthma exacerbations in children: a meta-analysis. Pediatrics. 2014 Mar;133(3):493-9.</ref>

Ostermayer: /* Criticisms & Further Discussion */

2015-09-23T11:51:58Z

Criticisms & Further Discussion

← Older revision		Revision as of 11:51, 23 September 2015
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	*PEFR is a more valid and reproducible measurement, but was performed in a minority of patients		*PEFR is a more valid and reproducible measurement, but was performed in a minority of patients
	**Can only be measured in kids older than 6 years, and in patients who are able to perform the test		**Can only be measured in kids older than 6 years, and in patients who are able to perform the test
	*No differentiation made between moderate and severe exacerbations		*No differentiation made between moderate and severe exacerbations so fine treatment differences cannot be determined
	*~~Conclusions~~ cannot be extrapolated to patients with severe asthma		*Only patients with mild and moderate asthma exacerbations were included in the study so conclusions cannot be extrapolated to patients with severe asthma
			*A meta-analysis in 2014 found no difference in relative risk of relapse between children (≤18) treated with dexamethasone (1 or 2 dose regimens) compared to 5 day oral prednisone<ref>Keeney GE et al. Dexamethasone for acute asthma exacerbations in children: a meta-analysis. Pediatrics. 2014 Mar;133(3):493-9.</ref>

	==Funding==		==Funding==

Catierey: formatting

2015-09-21T23:04:38Z

formatting

← Older revision		Revision as of 23:04, 21 September 2015
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	==Population==		==Population==
	===Patient Demographics===		===Patient Demographics===
	'''Dexamethasone vs. Prednisolone'''		'''Dexamethasone vs. Prednisolone''' <br/>
	Male: 64% vs. 64%		Male: 64% vs. 64% <br/>
	Caucasian: 34% vs. 40%		Caucasian: 34% vs. 40% <br/>
	Mean age at first diagnosis (months): 26 vs. 28		Mean age at first diagnosis (months): 26 vs. 28 <br/>
	Mean number of previous hospital admissions: 0.3 vs. 0.4		Mean number of previous hospital admissions: 0.3 vs. 0.4 <br/>
	Mean number of ED visits in last year: 1.6 vs. 1.7		Mean number of ED visits in last year: 1.6 vs. 1.7 <br/>
	Smokers at home: 16% vs. 15%		Smokers at home: 16% vs. 15% <br/>
	Pulmonary index score: 1.74 vs. 1.97		Pulmonary index score: 1.74 vs. 1.97 <br/>

	===Inclusion Criteria===		===Inclusion Criteria===

Catierey: further considerations

2015-09-21T23:02:50Z

further considerations

← Older revision		Revision as of 23:02, 21 September 2015
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	==Major Points==		==Major Points==
			*Mean number of days needed for Patient Self Assessment Score to return to baseline (0–0.5) in the Dex and Pred groups were 5.21
			versus 5.22 days.
			*Pulmonary index scores were similar in both groups at initial presentation, initial ED discharge and at the day 5 follow-up visit.
			*At the first visit, mean time to discharge was 3.5 h (±1.93) for Dex and 4.3 h (±3.67) for Pred
			*Initial admission rate was 9% (Dex) versus 13.4% (Pred).
			*There was no significant difference in the number of salbutamol therapies needed in the ED nor at home after discharge.
			*For subjects discharged home, the admission rate after initial discharge was 4.9% (Dex) versus 1.8% (Pred), resulting in overall hospital admission rates of 13.4% (Dex) and 14.9% (Pred)

	==Study Design==		==Study Design==
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	**Before starting treatment, PIS, vital signs, oxygen saturation, and peak expiratory flow rate (if pt ≥6 years old) were recorded		**Before starting treatment, PIS, vital signs, oxygen saturation, and peak expiratory flow rate (if pt ≥6 years old) were recorded
	*Pt reasssesed 20 minutes after first salbutamol, and if further treatment was needed the patient was consented to study		*Pt reasssesed 20 minutes after first salbutamol, and if further treatment was needed the patient was consented to study
	*All patients received second and third salbutamol 20 minutes apart		*All patients in study received second and third salbutamol 20 minutes apart
	**Decision to give more salbutamol after third dose was up to discretion of attending		**Decision to give more salbutamol after third dose was up to discretion of attending

	==Population==		==Population==
	===Patient Demographics===		===Patient Demographics===
			'''Dexamethasone vs. Prednisolone'''
			Male: 64% vs. 64%
			Caucasian: 34% vs. 40%
			Mean age at first diagnosis (months): 26 vs. 28
			Mean number of previous hospital admissions: 0.3 vs. 0.4
			Mean number of ED visits in last year: 1.6 vs. 1.7
			Smokers at home: 16% vs. 15%
			Pulmonary index score: 1.74 vs. 1.97

	===Inclusion Criteria===		===Inclusion Criteria===
	*2-16 years old who presented to the ED with acute mild to moderate asthma exacerbation		*2-16 years old who presented to the ED with acute mild to moderate asthma exacerbation
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	==Outcomes==		==Outcomes==
			N=134 eligible subjects consented and enrolled
			N=110 completed the study, 56 in the Dex group and 54 in the Pred group

	===Primary Outcome===		===Primary Outcome===
	*Primary outcome was number of days needed for Patient Self Assessment Score to return to baseline (score of 0-0.5)		*Primary outcome was number of days needed for Patient Self Assessment Score to return to baseline (score of 0-0.5)
	**Mean was 5.21 vs. 5.22 days (Dex vs. Pred)		**Mean was 5.21 vs. 5.22 days (Dex vs. Pred)

			{\| class="wikitable"
			\|-
			! Clinical picture !! 0 points !! 1 point !! 2 points !! 3 points
			\|-
			\| Wheeze \|\| None \|\| Some \|\| Medium \|\| Severe
			\|-
			\| Cough \|\| None (0.5 for very occasional cough--<8 coughs in the day, or <2/hr at night) \|\| Occasional \|\| Frequent \|\| Severe
			\|-
			\| Activity \|\| Normal \|\| Can run only short distances or climb 3 flights of stairs \|\| Can walk not run \|\| Missed school or stayed indoors
			\|-
			\| Sleep \|\| Normal \|\| Slept well with slight wheeze \|\| Awake 2 to 3 times at night with cough or wheeze \|\| Bad night, awake most of the time
			\|}

	===Secondary Outcomes===		===Secondary Outcomes===
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	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
			*Primary outcome is clinical scoring system that relies on parental interpretation of patient symptoms
			*PEFR is a more valid and reproducible measurement, but was performed in a minority of patients
			**Can only be measured in kids older than 6 years, and in patients who are able to perform the test
			*No differentiation made between moderate and severe exacerbations
			*Conclusions cannot be extrapolated to patients with severe asthma

Catierey: under review

2015-09-21T16:49:42Z

under review

← Older revision		Revision as of 16:49, 21 September 2015
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	\| fulltexturl= http://journals.lww.com/pec-online/Abstract/2006/12000/Single_Dose_Oral_Dexamethasone_in_the_Emergency.3.aspx		\| fulltexturl= http://journals.lww.com/pec-online/Abstract/2006/12000/Single_Dose_Oral_Dexamethasone_in_the_Emergency.3.aspx
	\| pdfurl= http://www.infomine.com/publications/docs/asthmapaper.pdf		\| pdfurl= http://www.infomine.com/publications/docs/asthmapaper.pdf
			\| status=Under Review
	}}		}}
	==Clinical Question==		==Clinical Question==

Catierey: study design

2015-09-18T22:58:35Z

study design

← Older revision		Revision as of 22:58, 18 September 2015
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	}}		}}
	==Clinical Question==		==Clinical Question==
	~~What is the efficacy~~ of a single dose of oral dexamethasone ~~as compared~~ with 5 days of twice-daily prednisolone in the treatment of mild to moderate asthma exacerbations in children seen in the emergency department?		How does a of a single dose of oral dexamethasone compare with 5 days of twice-daily prednisolone in the treatment of mild to moderate asthma exacerbations in children seen in the emergency department?

	==Conclusion==		==Conclusion==
			A single dose of oral dexamethasone (0.6 mg/kg) is no worse than 5 days of twice-daily prednisolone (1 mg/kg per dose) in the management of children with mild to moderate asthma exacerbations.

	==Major Points==		==Major Points==

	==Study Design==		==Study Design==
			*Prospective, randomized, double-blinded trial conducted at British Columbia Children's Hospital
			*All children presenting to the ED with mild to moderate asthma exacerbations were assessed by the emergency attending physician who decided if the child needed treatment with salbutamol
			**Before starting treatment, PIS, vital signs, oxygen saturation, and peak expiratory flow rate (if pt ≥6 years old) were recorded
			*Pt reasssesed 20 minutes after first salbutamol, and if further treatment was needed the patient was consented to study
			*All patients received second and third salbutamol 20 minutes apart
			**Decision to give more salbutamol after third dose was up to discretion of attending

	==Population==		==Population==
	===Patient Demographics===		===Patient Demographics===
	===Inclusion Criteria===		===Inclusion Criteria===
			*2-16 years old who presented to the ED with acute mild to moderate asthma exacerbation
			**Mild to moderate asthma exacerbation defined as a Pulmonary Index Score (PIS) of less than 9 or a PEFR ≥ 60% of predicted value by height
			*History of at least 1 prior episode of ‘‘asthma-like’’ acute shortness of breath or wheezing that was treated with salbutamol

	===Exclusion Criteria===		===Exclusion Criteria===
			*Signs of severe asthma on presentation
			**PEFR < 60%, PIS ≥ 10
			*Complete recovery after first salbutamol therapy
			*Use of oral steroids in the last 2 weeks
			*History of severe asthma exacerbation, including prior intubation or ICU admission for asthma
			*Chronic lung disease
			*Heart disease
			*Neurological disorder
			*Psychiatric disease
			*History of acute allergic reaction
			*Active chickenpox or herpes simplex infections

	==Interventions==		==Interventions==
			*Patients received single-dose oral dexamethasone (0.6 mg/kg to a maximum of 18 mg) or oral prednisolone (1 mg/kg per dose to a maximum of 30 mg)
			twice daily for 5 days
			*Pts were contacted by telephone at 48 hrs to assess symptoms and reevaluated in the ED in 5 days

	==Outcomes==		==Outcomes==


	===Primary Outcome===		===Primary Outcome===
			*Primary outcome was number of days needed for Patient Self Assessment Score to return to baseline (score of 0-0.5)
			**Mean was 5.21 vs. 5.22 days (Dex vs. Pred)

	===Secondary Outcomes===		===Secondary Outcomes===
			*Mean time to discharge: 3.5 hours vs. 4.3 hours
			*Initial admission rate: 9% vs. 13.4%
			*Re-admission rate after initial discharge: 4.9% vs. 1.8%
			*Overall hospital admission rate: 13.4% vs. 14.9%
			*No significant difference in the number of salbutamol therapies needed in the ED nor at home after discharge

	===Subgroup analysis===		===Subgroup analysis===

Catierey: pdf link

2015-09-18T19:24:24Z

pdf link

← Older revision		Revision as of 19:24, 18 September 2015
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	\| pmid= 17198210		\| pmid= 17198210
	\| fulltexturl= http://journals.lww.com/pec-online/Abstract/2006/12000/Single_Dose_Oral_Dexamethasone_in_the_Emergency.3.aspx		\| fulltexturl= http://journals.lww.com/pec-online/Abstract/2006/12000/Single_Dose_Oral_Dexamethasone_in_the_Emergency.3.aspx
	\| pdfurl=		\| pdfurl= http://www.infomine.com/publications/docs/asthmapaper.pdf
	}}		}}
	==Clinical Question==		==Clinical Question==