The primary therapies for acute asthma exacerbations are the administration of a rapid-acting beta 2 agonist, the early introduction of systemic glucocorticosteroids, and oxygen supplementation.
The aim of this study was to test the effectiveness of dexamethasone when given by inhalation in combination with saibutamol in the treatment of acute asthma attacks of moderate severity and to compare it with systemic steroids given by conventional methods, namely, the oral and parenteral routes. The study was conducted on a total of 60 children, 1 to 12 years old, with a history of stable bronchial asthma and suffering from acute exacerbations of moderate severity. Asthmatic children were divided at random into 3 equal groups each of 20, and within 5 minutes of their first saibutamol nebulization, they were given either [a] Nebulized dexamethasone in a dose of 1mg/kg, maximum 16mg [group I] , [b] Oral prednisone in a dose of 1mg/kg [group II] , or [c] Intravenous hydrocortisone in a dose of 4 mg/kg [group III] . Nebulized saibutamol was repeated for all patients an hourly basis for 3 hours and later every 2 hours. Comparison was made between the three groups by repeating a pulmonary index [PI] score at 3 and 6 hours after steroid administration. Assessment after 3 hours revealed that:  . The mean PI and respiratory rate in the dexamethasone group were significantly lower than in the oral prednisone group with no significant difference in these parameters between the dexamethasone and the parenteral hydrocortisone group.  . There was a significant improvement in the PI, respiratory rate, and oxygen saturation in all studied groups when compared to baseline data. Assessment after 6 hours revealed no statistically significant differences between the three studied groups as regards the PI, respiratory rate, and oxygen saturation. Conclusion: Dexamethasone, when given by inhalation in combination with saibutamol is at least as effective as oral and parenteral steroids for first line therapy of acute asthma exacerbations of moderate severity, moreover, it is associated with more rapid improvement when compared to oral steroids
Galal H. Aref ,Galal H. Aref ,Omneya M. Badr EI Din ,Ihab H. EI Sawy ,Ashraf A. Galal ,N. E. Hassan ,
Nebulized dexamethasone in comparison to oral prednisone and intravenous hydrocortisone in the treatment of acute attacks of bronchial asthma in children,
Alex. J. Pediatr. 2003;
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