All adults with chickenpox, including HIV-infected patients, are at risk of varicella pneumonia; the risk is especially high for pregnant women with varicella. Varicella pneumonia is much less common in children. Although many patients have only mild respiratory symptoms, severe pulmonary involvement (with hypoxemia, cyanosis, and death) can occur. For this reason, all adults with chickenpox should be followed closely for respiratory symptoms. Chest radiography is warranted for patients who experience dyspnea, cough, or other respiratory symptoms. Radiographic abnormalities in VZV pneumonia are more pronounced than are clinical signs and symptoms, and they include diffuse coalescent nodular densities.
Study objective: To compare nebulized dexamethasone with oral prednisone in the treatment of children with asthma. Design: A randomized, double-blind, double-placebo study. Setting: An urban pediatric emergency department. Participants: Patients aged 1 to 17 years with acute asthma. Interventions: Patients with moderate asthma exacerbation received frequent aerosolized albuterol and either mg/kg of nebulized dexamethasone or 2 mg/kg of oral prednisone. Results: A total of 111 children was evaluated; 21% of those treated with dexamethasone required hospitalization, compared with 31% of those treated with prednisone ( P =.26). A significantly greater proportion of dexamethasone-treated children were discharged home within 2 hours (23% versus 7%, P =.02). In the dexamethasone group, 8% who received the drug by mouthpiece were hospitalized compared with 33% who received it by face mask ( P =.06). Fewer children treated with dexamethasone vomited (0% versus 15%, P =.001) and fewer relapsed within 48 hours of ED discharge (0% versus 16%, P =.008). Conclusion: Nebulized dexamethasone was as effective as oral prednisone in the ED treatment of moderately ill children with acute asthma and was associated with more rapid clinical improvement, more reliable drug delivery, and fewer relapses. [Scarfone RJ, Loiselle JM, Wiley JFII, Decker JM, Henretig FM, Joffe MD: Nebulized dexamethasone versus oral prednisone in the emergency treatment of asthmatic children. Ann Emerg Med October 1995;26:480-486.]