Recommended Dose of Dexamethasone for Asthma in Children
For children with asthma exacerbations, a single dose of oral dexamethasone at 0.3-0.6 mg/kg (maximum 18 mg) is the recommended dosing regimen, which is as effective as a 3-5 day course of prednisolone. 1, 2, 3
Dosing Options for Asthma Exacerbations in Children
Dexamethasone Regimen
- Single dose approach: 0.3-0.6 mg/kg (maximum 18 mg) 1, 2, 3
- Benefits:
- Longer half-life (36-72 hours)
- Better compliance (single dose vs. multiple days)
- No reported vomiting compared to prednisolone 2
- Similar efficacy to multi-day prednisolone regimens
Alternative Corticosteroid Options
- Prednisolone: 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 1
- Hydrocortisone (IV for severe cases): Intravenous hydrocortisone for immediate treatment of severe asthma 4
Clinical Decision-Making
Severity Assessment
Mild to Moderate Exacerbations:
Severe Exacerbations:
- Consider IV hydrocortisone initially if patient has:
- PEF <33% predicted
- Poor respiratory effort
- Cyanosis or silent chest
- Fatigue or reduced consciousness 4
- Consider IV hydrocortisone initially if patient has:
Administration Considerations
- Route: Oral administration is preferred for non-life-threatening exacerbations 1
- Timing: Early administration (aim for within 30-40 minutes of arrival) improves outcomes 5
- Follow-up: Schedule follow-up within 1 week after treatment 1
Monitoring Response
- Measure peak expiratory flow (PEF) 15-30 minutes after starting treatment
- Maintain oxygen saturation >92%
- Chart PEF before and after bronchodilator treatments 4
Important Considerations
Advantages of Dexamethasone
- Better compliance due to single dosing
- Less vomiting than prednisolone (0% vs 11.5% in studies) 2
- Similar clinical outcomes to prednisolone for mild-moderate exacerbations 2, 3
- No difference in 30-day reutilization rates between dexamethasone and prednisolone 6
Potential Drawbacks
- Higher rate of additional steroid courses within 14 days (13.1% vs 4.2% with prednisolone) 2
- Limited data for very severe exacerbations
Transfer to Intensive Care
Consider transfer to ICU if patient shows:
- Deteriorating PEF
- Worsening hypoxia
- Confusion or drowsiness
- Exhaustion or respiratory arrest 4
Discharge Criteria
Patients should have:
- Been on discharge medication for 24 hours
- PEF >75% of predicted or personal best
- Treatment plan with bronchodilators and inhaled steroids
- Follow-up arranged within 1 week 4, 1
The evidence strongly supports that a single dose of dexamethasone (0.3-0.6 mg/kg) is an effective, convenient, and well-tolerated option for treating asthma exacerbations in children, with outcomes comparable to traditional multi-day prednisolone regimens.