Background: Acute wheezing is a common cause of morbidity and hospitalization in preschool children. Oral corticosteroids (OCS), prednisolone, prednisone and dexamethasone, have a central role in treatment. Betamethasone, a more palatable long acting OCS, is widely used for treating acute wheezing and asthma in children, however, evidence-based data to support its efficacy is surprisingly scant.
Aim: To compare hospitalization outcomes of preschool children with acute wheezing between two pediatric wards of the same medical center with two different OCS protocols – dexamethasone (0.3mg/kg/day) vs betamethasone (0.2mg/kg/day).
Methods: A retrospective cohort analysis of all preschool children hospitalized with an acute wheezing attack at two campuses of Hadassah Medical Center – Ein Kerem and Mt. Scopus, between 2014 - 2017. Days of hospitalization served as the primary outcome. Children with chronic medical conditions or those admitted to ICU were excluded.
Results: Ninety-eight patients (mean age=3.9±1.4 yr) were recruited, 49 in each group. Physician-diagnosed asthma was reported in 41.8%, while 11.2% were prescribed a controller. There were no significant differences between the two OCS groups in patient demographical or clinical characteristics, severity of the wheezing attack upon arrival to ED or average hospitalization length (2.2±1.5 days). The cumulative prednisone-equivalent dose of OCS was significantly higher for dexamethasone as opposed to bethamethasone group (3.9 mg/kg vs. 2mg/kg respectively, p<0.01).
Conclusions: Betamethasone offers an equivalent and a more palatable treatment, compared to dexamethasone, in preschool children hospitalized due to acute wheezing attack, with potentially lower OCS dose needed to achieve a similar rate of clinical improvement.
