Parent initiated prednisolone for acute asthma in children of school age: randomised controlled crossover trial
Abstract
Objective To evaluate the efficacy of a short course of parent initiated oral prednisolone for acute asthma in children of school age.
Design
Double blind, randomised, placebo controlled, crossover trial in which
episodes of asthma, rather than participants, were randomised to
treatment.
Setting The Barwon region of Victoria, Australia.
Participants Children aged 5-12 years with a history of recurrent episodes of acute asthma.
Intervention A short course of parent initiated treatment with prednisolone (1 mg/kg a day) or placebo.
Main outcome measures
The primary outcome measure was the mean daytime symptom score over
seven days. Secondary outcome measures were mean night time symptom
score over seven days, use of health resources, and school absenteeism.
Results
230 children were enrolled in the study. Over a three year period, 131
(57%) of the participants contributed a total of 308 episodes of asthma
that required parent initiated treatment: 155 episodes were treated with
parent initiated prednisolone and 153 with placebo. The mean daytime
symptom score was 15% lower in episodes treated with prednisolone than
in those treated with placebo (geometric mean ratio 0.85, 95% CI 0.74 to
0.98; P=0.023). Treatment with prednisolone was also associated with a
16% reduction in the night time symptom score (geometric mean ratio
0.84, 95% CI 0.70 to 1.00; P=0.050), a reduced risk of health resource
use (odds ratio 0.54, 95% CI 0.34 to 0.86; P=0.010), and reduced school
absenteeism (mean difference −0.4 days, 95% CI −0.8 to 0.0 days;
P=0.045).
Conclusion A short course of
oral prednisolone initiated by parents when their child experiences an
episode of acute asthma may reduce asthma symptoms, health resource use,
and school absenteeism. However, the modest benefits of this strategy
must be balanced against potential side effects of repeated short
courses of an oral corticosteroid.
Trial registration ISRCTN 26232583.
Edited from bmj.com
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