Impact of a Discharge Prescription for Dexamethasone on Outcomes of Children Treated in the Emergency Department for Acute Asthma Exacerbations

To evaluate whether a discharge prescription for dexamethasone prevents treatment failure in children with acute asthma exacerbations treated in the emergency department (ED) and to describe prescribing practices and caregiver adherence.The study included 564 children aged 2 to 18 years who were treated for acute asthma exacerbations at a tertiary-care children’s hospital ED between October 2018 and March 2022 and were discharged after receiving oral dexamethasone. Children were excluded if they had recent or alternative corticosteroid use, did not receive dexamethasone, required hospitalization, or had select comorbidities.This prospective, observational cohort study collected data through medical record review, including demographics, clinical characteristics, and ED treatment course. The exposure was a discharge prescription for a second dose of dexamethasone (2-dose regimen) compared with no prescription after the initial ED dose (single-dose regimen). The primary outcome was treatment failure, defined as a return ED visit, an unplanned primary care visit, or ongoing bronchodilator use 7 to 10 days after discharge. Outcomes were assessed via telephone follow-up. The association between dexamethasone dosing regimen and treatment failure was evaluated while adjusting for potential confounders.Among 564 children, 85.5% received a discharge prescription for dexamethasone. The 2-dose regimen was significantly associated with more severe exacerbations, a higher number of combined albuterol/ipratropium treatments, and longer ED length of stay. Notably, caregivers did not administer the additional dose in 17.9% of prescribed cases. Treatment failure occurred in 52.1% of participants; however, there was no statistically significant association between the 2-dose dexamethasone regimen and treatment failure (relative risk = 0.87; 95% CI 0.67, 1.12).Prescribing an additional dose of dexamethasone at discharge for children with acute asthma exacerbations did not reduce treatment failure or improve patient-centered outcomes.Systemic corticosteroids are a cornerstone of treatment for acute asthma exacerbations. Dexamethasone is an effective option due to its shorter dosing regimen and longer duration of action; however, the optimal dosing strategy remains unclear. This study found no clinical benefit when a second dose of dexamethasone was prescribed at discharge, suggesting that a single ED dose may be sufficient for most children with mild to moderate exacerbations.