A new study published in the September 2015 issue of the Journal of Pediatrics finds that administering dexamethasone to patients admitted for asthma exacerbation at children's hospitals had shorter hospital stays, resulting in admission cost savings of 8 percent over patients who received prednisone, a commonly used steroid for these inpatients. Of patients administered dexamethasone, 67 percent had a length of stay of one day, compared to 60 percent of patients administered prednisone. Only 7 percent of the patients administered dexamethasone had length of stay of three or more days while 12 percent of the group administered prednisone had hospitalizations of three or more days.

The study, "Comparative Effectiveness of Dexamethasone Versus Prednisone in Children Hospitalized with Asthma," coauthored by Children's Health pediatric hospitalist Vineeta Mittal, M.D., also an associate professor of pediatrics at UT Southwestern Medical Center, was the first time that the two steroids commonly administered to patients with asthma exacerbations were compared for patients who are hospitalized. Prior studies have compared these steroids in the emergency department setting; however, this study focuses on the use of dexamethasone for inpatients.

The authors attribute dexamethasone's impact on asthma patients' length of stay to its longer effectiveness, palatable taste and milder side effects. The authors also theorize that these same factors, in addition to an overall short course (dexamethasone is often given as a two-day course, compared to prednisone, which is given as a five-day course), may help in adherence to medication usage among patients who are hospitalized, potentially resulting in lower readmission rates. A two-day dosage of dexamethasone is equivalent to a five-day dosage of prednisone, which is bitter-tasting and associated with vomiting as a side effect.

"Asthma is the most common chronic condition leading to hospitalizations in children's hospitals across the nation," Mittal said. "Medication compliance is especially important for children hospitalized with asthma exacerbation since these children tend to be at risk for readmissions due to their chronic medical condition and associated socio-economic factors. Using a two-day steroid versus a five-day steroid medication helps with compliance, also."

From 2001 to 2010, the prevalence of asthma in adults and children has increased from 7.3 percent of the population in 2001 to 8.4 percent in 2010. In 2010, more than 7 million children under the age of 18 were affected by asthma. While the rate of pediatric hospitalizations for asthma has declined from 165,000 in 2000 to 130,000 in 2010, the average cost per asthma-related hospital stays has remained the same at $3,600 from 2000 to 2010. Children from low-income communities have consistently higher rates of hospital stays for asthma than those in wealthier communities. Medicaid was the most frequent payer for children with asthma.

"Longer lengths of stays in patients admitted to the hospital with asthma exacerbations cause significant morbidity in both patients and the families," said Yadira Rivera-Sanchez, M.D., director of inpatient service, pulmonary division, and medical director of the pulmonary advanced practice provider program at Children's Health. She is also a pulmonologist and associate professor of pediatrics at UT Southwestern. "From the pulmonary specialist standpoint, our population involves patients with more difficult-to-control asthma with overall higher morbidity than the general asthma population. This study demonstrates a significantly decreased length of stay with the use of dexamethasone when compared to prednisone with a similar side-effect profile."

Since the publication of the study, Children's Health Director of Emergency Services Halim Hennes, M.D., said the hospital system is prescribing dexamethasone more frequently to children who present to the emergency department (ED) with acute asthma exacerbation.

"This study confirms the results from prior ED-based studies that two days of dexamethasone is as effective as five days of prednisone in children with acute asthma exacerbation," said Hennes, who is also a professor of pediatrics and emergency medicine at UT Southwestern and division chief of pediatric emergency medicine.

About the Study

The study used data from the Children's Hospital Association's Pediatric Health Information System (PHIS) a comparative pediatric database of clinical and resource utilization data for inpatient, ambulatory surgery, emergency department and observation unit patient encounters for 45 children's hospitals. The study looked at children with the principal diagnosis of asthma, ages 4 to 17, who were hospitalized between Jan. 1, 2007, through Dec. 31, 2012. The study population included otherwise well patients who were admitted for non-severe asthma exacerbations with mild to moderate symptoms and did not require intensive unit care. Patients who received a combination of dexamethasone and either prednisone/prednisolone were excluded from the analysis, as were children with severe symptoms requiring ICU admission and children with medical complexity. In addition to Children's Health, study authors represented the following institutions:

  • Children's National Health System, Washington, D.C.
  • Children's Mercy Hospitals and Clinics, Kansas City, Mo.
  • New York-Presbyterian Morgan Stanley Children's Hospital, New York, N.Y.
  • Hospital for Sick Kids, Toronto, Ontario, Canada
  • Children's Hospital Colorado, Aurora, Colo.
  • Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
  • Children's Hospital Association