Randomized trial of dexamethasone versus prednisone for children with acute asthma exacerbations: why?

Paniagua et al reported data that showed no difference between 2 doses of dexamethasone and 5 days of prednisone or prednisolone. However, more than one-half the patients were still symptomatic at day 7 (see Table II in their article).1 An equally legitimate interpretation of the data is that the 2 regimens were equally ineffective. Although some may consider the efficacy of corticosteroids for acute asthma self-evident, there has been controversy in the literature on this subject. Oral corticosteroids were first demonstrated in 1956 to have benefit for adults in favorably altering the course of an asthma exacerbation to a greater extent than just "antispasmodics" [sic].

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