Written by Joshua Belfer
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While most children discharged after an asthma exacerbation receive two doses of dexamethasone, this retrospective cohort study found no difference in ED revisits or hospitalizations compared with a single-dose regimen.
Twice as nice? Maybe not.
Asthma exacerbations account for more than 700,000 ED visits annually, but evidence and guidelines vary with regard to a one- or two-dose regimen of dexamethasone. This study assessed the risk of ED revisit for those children with asthma exacerbation discharged from the ED who received treatment with one dose rather than two doses of dexamethasone.
In this retrospective cohort study of 2,063 children 2–20 years, 38.1% received a single dose of dexamethasone and 61.9% received two doses. In the propensity-score-weighted cohort, there was no significant difference in risk of an ED revisit (5.2% for one dose, 5.7% for two doses, risk difference 0.45%, 95%CI -1.4% to 2.3%). The risk of hospitalization within 14 days, a secondary outcome evaluated, also showed no significant difference (0.85% for one dose, 0.83% for two doses, risk difference 0.02%, 95%CI -0.93% to 0.89%).
Given the study’s retrospective design, the associations seen may not be causal. Additionally, investigators could not confirm that the second dose of dexamethasone, when prescribed, was taken.
How will this change my practice?
At my institution, it is pretty routine that every child with an asthma exacerbation is discharged with a second dose of dexamethasone 24–48 hours after the one given in the ED. This study suggests that there may not be additional benefit seen in ED revisits or hospitalizations with this second dose. I’m not sure this single study will push me to stop at one dose—yet. I would love to see more data exploring whether there is a subgroup of patients that may benefit from a second dose, particularly children with more severe illness. Additionally, future studies could examine outcomes beyond ED revisits and hospitalization, such as symptom resolution or bronchodilator use. If we are able to reduce standard regimens to one dose of dexamethasone, I think that’d be great, but I will stay tuned for further research before changing my current practice.
Source
https://emergencymed.org.il/wp-content/uploads/2026/09/Dexamethasone-Treatment-Regimen-and-Clinical.pdfhttps://emergencymed.org.il/wp-content/uploads/2026/09/Dexamethasone-Treatment-Regimen-and-Clinical.pdf. Ann Emerg Med. 2026 Jul;88(1):46-54. doi: 10.1016/j.annemergmed.2025.12.010. Epub 2026 Jan 23. PMID: 41575401.
