Dexamethasone for acute wheeze exacerbations in children: have the associated risks been fully considered?

Oral corticosteroids (OCS) are a cornerstone of treatment for acute asthma in children. When used appropriately, they reduce airway inflammation, shorten the duration of symptoms, decrease hospital admission and reduce relapse following emergency department (ED) discharge.1 Their benefit is well established in school-aged children with acute asthma exacerbations, and they remain embedded within national and international guidance.1 2 However, OCS are not without harm, and many children, particularly those with recurrent wheeze, are exposed repeatedly over early childhood.3 As such, optimal OCS prescribing must balance efficacy against cumulative exposure, making corticosteroid stewardship a central component of high-quality paediatric emergency care.