The efficacy of dexamethasone compared to prednisone/prednisolone for the management of pediatric patients with acute exacerbation of asthma: a systematic review and meta-analysis

This updated meta-analysis aimed to investigate the efficacy of dexamethasone compared to prednisone/prednisolone for the management of pediatric patients with acute exacerbation of asthma. PubMed, Web of Science, the Cochrane Library, and Scopus were systematically searched from the inception to March 8, 2025. Randomized controlled trials comparing the effect of dexamethasone with prednisone/prednisolone on hospital admission, relapse, readmission, length of hospital stay, pediatric respiratory assessment measure (PRAM) score, intensive care unit (ICU) admission, non-compliance, and vomiting among pediatric patients with acute asthma exacerbation were identified. Studies other than randomized controlled trials, studies lacking both groups and those not reporting the outcomes of interest were excluded. A random-effects model was adopted to pool data. Sixteen studies with 1481 individuals in the dexamethasone group and 1436 individuals in the prednisone/prednisolone group were included. No significant differences were found between dexamethasone and prednisone/prednisolone groups in terms of the risk of hospitalization (RR 0.96, 95% CI (0.79, 1.17), I2=0.00%), ICU admission (RR 0.64, 95% CI (0.08, 4.88), I2=0.00%), relapse (RR 0.99, 95% CI (0.71, 1.38), I2=0.00%), hospital readmission (RR 0.90, 95% CI (0.34, 2.35), I2=30.98%), the PRAM score (RR -0.24, 95% CI (-0.54, 0.06), I2=41.30%), the length of hospital stay (RR -2.69 hours, 95% CI (-6.91, 1.53), I2=69.50%), and non-compliance (RR 0.47, 95% CI (0.07, 3.01), I2=65.20%). Moreover, dexamethasone decreased the risk of vomiting (RR 0.39, 95% CI (0.25, 0.59), I2=26.62%) compared to prednisone-prednisolone. Dexamethasone was not inferior to prednisolone/prednisone in the management of pediatric asthma exacerbation.