Giving Asthmatics Intramuscular Steroids for Preventing Return to the Emergency Department (GASPING)

Montefiore Medicine Academic Health System

Status and phase: Not yet enrolling; Phase 4

Conditions: Asthma

Treatments: Drug: Prednisone 60mg PO; Drug: Dexamethasone 16mg IM

Study type: Interventional

Funder types: Other

Identifiers

NCT07228052

2025-16648

Details and patient eligibility

About

This study aims to compare the efficacy of a one-time IM dose of dexamethasone versus a 5-day course of prednisone in adult ED patients presenting with asthma exacerbations. This is a randomized, controlled, double-blind, non-inferiority trial conducted at two urban EDs within the Montefiore Health System.

Full description

Asthma exacerbations are a leading cause of emergency department (ED) visits in the United States. In pediatric patients, a single dose of dexamethasone has been widely adopted as an effective and convenient alternative to multi-day oral steroid regimens. However, in adults, evidence regarding the efficacy of a single-dose steroid approach compared to a traditional 5-day course of oral prednisone is mixed. Despite the availability of oral corticosteroids like prednisone, medication adherence after ED discharge remains a significant challenge. Studies indicate that only about 30% of ED patients fill prescribed medications post-discharge. A single-dose intramuscular (IM) dexamethasone regimen offers the advantage of ensuring adequate anti-inflammatory effects for asthma exacerbations. This study aims to compare the efficacy of a one-time IM dose of dexamethasone versus a 5-day course of prednisone in adult ED patients presenting with asthma exacerbations.

Enrollment: 182 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adults ≥18 years old presenting to the ED with an asthma exacerbation
• Diagnosed with asthma per International Classification of Diseases, 10th Revision (ICD-10) criteria or by the treating clinician
• Discharged from the ED with a primary diagnosis of asthma exacerbation
• Initiated systemic corticosteroids during the ED visit
• Must be English or Spanish speaking

Exclusion criteria

• Current use of systemic corticosteroids, including Emergency Medical Services (EMS) administration before ED arrival
• History of severe adverse reactions to corticosteroids
• Heart failure and uncontrolled diabetes (glucose >300mg/dL in the ED)
• Pregnancy or breastfeeding as prednisone is the preferred treatment for asthma in this population
• Inability to provide informed consent

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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182 participants in 2 patient groups

Single Intramuscular Steroid Injection

Active Comparator group

Description:

Dexamethasone 16mg Intramuscular Single Dose

Treatment:

Drug: Dexamethasone 16mg IM

Oral Steroid Short Course

Active Comparator group

Description:

Prednisone 60mg PO for 5 Days

Treatment:

Drug: Prednisone 60mg PO