Al‐Wahadneh 2006.

Methods	A prospective, randomised, non‐blinded clinical trial Comparison of IM dexamethasone to oral prednisolone Randomisation and allocation concealment methods were reported but methods were not described
Participants	Patients with known history of asthma who presented to the ED with a moderate asthma exacerbation who did not require admission on presentation and had no evidence of varicella exposure or fever and did not take any systemic corticosteroids within 2 weeks of the start of the study A locally modified scoring system based on GINA guidelines for the management of asthma was used to evaluate the clinical response at presentation, and 5 days after treatment. Ages: enrolled patients 9 months to 14 years. Mean age of IM corticosteroid group: 79.7 months. Mean age of oral corticosteroid group: 45.4 months Reported enrolling patients with mild‐moderate exacerbations. Unable to assess exacerbation severity based on baseline PEF Set in Jordan Sex: 20 men, 9 women
Interventions	Interventions: single IM dose of dexamethasone (1.7 mg/kg; mean steroid dosage: 24 mg) versus oral prednisolone (2 mg/kg/day; mean steroid dosage: 19.2 mg per day) for 5 days. No placebo was provided for either group Co‐interventions in the ED: not reported Co‐interventions at discharge: salbutamol (100 mcg/puff; 1 puff every 4 to 6 hours as needed)
Outcomes	Change in clinical asthma score from day 1 through day 5 of treatment. Relapse (defined as unscheduled patient returns due to symptoms and signs requiring treatment with systemic corticosteroids after initial clearance within 21 days of treatment) Clearing of an asthma exacerbation (defined as resolving of asthma symptoms and signs, the use of salbutamol less than 2 puffs per day and an additional course of systemic corticosteroids were not considered necessary)
Notes	Authors did not respond to requests for clarification. No registered protocol was identified.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	No information provided on how patients were randomised. Quote (p. 16): "Patients were randomised to receive either a single Intramuscular (IM) dose of dexamethasone acetate (1.7 mg/kg) or prednisolone taken orally each day for 5 days (2 mg/kg//day)."
Allocation concealment (selection bias)	Unclear risk	Study did not comment on allocation concealment.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Reported as a non‐blinded study. Quote (p. 16): "The study is prospective randomised and non‐blinded."
Blinding of outcome assessment (detection bias) All outcomes	High risk	Reported as a non‐blinded study. Quote (p. 16): "The study is prospective randomised and non‐blinded."
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Insufficient reporting of attrition/exclusions to permit a judgement.
Selective reporting (reporting bias)	Unclear risk	No protocol available.
Other bias	Unclear risk	Source of funding not provided. Baseline imbalance detected, dexamethasone group significantly older than prednisolone group. Quote (p. 16): "Males out‐numbered females in both groups (13:4 in the dexamethasone group, and 7:5 in the second group). Patients in dexamethasone acetate group were older than those in prednisolone group (P = 0.007), which can risk of bias ably be explained by the small‐sized sample and the random assignment of patients to either group."