This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Asthma is a common presenting problem to the Pediatric Emergency Department (ED). The control of an asthma exacerbation centers on bronchodilator therapy as well as the use of corticosteroids. Most physicians use a five day course of oral prednisone for this steroid burst. Problems with this regimen include poor patient/parent compliance, poor palatability, and side effects. Dexamethasone is 5-6 times more potent and has a 4-5 time longer half-life than prednisone. This may allow for the treatment of asthma exacerbations with a shorter course of dexamethasone, which could conceivably improve compliance. Our goal is to compare the efficacy of oral dexamethasone to oral prednisone in the management of acute pediatric asthma. This study will be a prospective, randomized, double-blind trial. The study will take place in the ED of The Children's Hospital, Denver. Our plan is to enroll 700 patients in each treatment arm. The primary outcome measure is relapse within 7 days, defined as need for subsequent hospitalization or an unscheduled visit with a medical provider due to continued symptoms. Secondary outcome measures include: change in spirometry measurements, need for subsequent steroids; side effects of the medicines; persistence of asthma symptoms; compliance with medication; missed days of school/work; and decrease in normal activities.
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