Presentations

Abstract

Introduction:

Half of children with asthma experience at least one asthma exacerbation each year. Some require repeat treatments due to ongoing or worsening asthma. Some research exists exploring dexamethasone vs. prednisone/prednisolone outcomes showing equally efficacy, but limitations include exclusion of severe asthma, use of lower prednisone doses, and outcomes based on subjective reporting. Some studies report reduced risk of vomiting with dexamethasone. Clinicians from this group have anecdotally noted that some patients initially treated with dexamethasone end up requiring a course of oral prednisone/prednisolone. Little data exists on characteristics that predict the need for a second or longer course of steroids.

Methods:

We performed a retrospective chart review of pediatric patients who had a visit to the CHKD emergency department in 2022 for asthma exacerbation/wheezing based on ICD-10 codes and who received a systemic steroid. Data collected included symptoms, exam, treatments, testing, and disposition. Charts were reviewed one month after the initial visit to assess for return visits where subsequent systemic steroids were prescribed for ongoing asthma exacerbation.

Results:

The majority of patients were under 6 years of age. Patients classed with more severe asthma (p<0.001), prior admission (p<0.001), or previously seen by a subspecialist for asthma (p=0.024) were significantly more likely to be admitted. The likelihood of positive RP2 testing, for Human rhinovirus/enterovirus (p=0.029) and Parainfluenza(p=0.025), were significantly higher among admitted patients. No association with vomiting was identified.

Conclusion:

Factors like asthma severity, past admissions, and previous specialist visits were significant for patients needing to be admitted. Dexamethasone was the most frequently used systemic steroid. More data is needed to make a statistically significant comparison with prednisone/prednisolone/methylprednisolone. Patients who received prednisone/methyl prednisone in the ER had a higher rate of admission, however a confounding variable is that this subset of patients had more severe asthma classifications. Viral illnesses were significant for admission. They were also associated with repeat visits, but this was not statistically significant. These factors could be considered as a part of a comprehensive assessment by clinicians when considering disposition and follow-up plans. More data is needed on factors associated with repeat visits.