Which medications in the drug class Systemic Corticosteroids are used in the treatment of Pediatric Asthma?

Updated: Jan 08, 2019
  • Author: Girish D Sharma, MD, FCCP, FAAP; Chief Editor: Kenan Haver, MD  more...
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Answer

Systemic Corticosteroids

These agents are used for short courses (3-10 d) to gain prompt control of inadequately controlled acute asthmatic episodes. They are also used for long-term prevention of symptoms in severe persistent asthma as well as for suppression, control, and reversal of inflammation. Frequent and repetitive use of beta2-agonists has been associated with beta2-receptor subsensitivity and downregulation; these processes are reversed with corticosteroids.

Higher-dose corticosteroids have no advantage in severe asthma exacerbations, and intravenous administration has no advantage over oral therapy, provided that GI transit time or absorption is not impaired. The usual regimen is to continue frequent multiple daily dosing until the FEV1 or peak expiratory flow (PEF) is 50% of the predicted or personal best values; then, the dose is changed to twice daily. This usually occurs within 48 hours.

Prednisone (Deltasone, Orasone) and prednisolone (Pediapred, Prelone, Orapred)

An immunosuppressant for the treatment of autoimmune disorders, prednisone may decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear neutrophil (PMN) activity.

Methylprednisolone (Solu-Medrol)

Methylprednisolone may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

Dexamethasone (Baycadron, Dexamethasone Intensol)

Dexamethasone in the ED can provide equivalent relief to a 5-day course of prednisone—and without the adverse side effect of vomiting—for acute asthma flare-ups in children. Researchers performed a meta-analysis of 6 studies based in the ED and found that significantly fewer patients receiving dexamethasone vomited in the ED or at home after discharge compared with patients receiving oral prednisone or prednisolone. The data suggest that emergency physicians should consider single or 2-dose dexamethasone regimens over 5-day prednisone/prednisolone regimens for the treatment of acute asthma exacerbations.


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