Is parent initiated steroid therapy efficacious in childhood asthma?

January 01, 0001

Is parent initiated steroid therapy efficacious in childhood asthma?

These Australian investigators sought to evaluate the efficacy of a parent initiated prednisolone burst for asthma exacerbations in children. They implemented a double blind, randomized, placebo controlled, crossover trial comparing prednisolone (1 mg/kg a day) or placebo. Asthma exacerbations rather than participants were randomised to treatment. Children ages 5-12 with recurrent asthma were recruited in the Barwon region of Victoria.

The investigators report: "30 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). Treatment with prednisolone was also associated with a 16% reduction in the night time symptom score (geometric mean ratio 0.84), a reduced risk of health resource use (odds ratio 0.54), and reduced school absenteeism (mean difference -0.4 days)."

The authors concluded: "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."

Parent initiated oral steroid therapy may be modestly efficacious in treating asthma exacerbations, although the risks remain unclear.

For the full abstract, click here.

BMJ 340:c843, 1 March 2010
© 2010 Vuillermin et al.
Parent initiated prednisolone for acute asthma in children of school age- randomised controlled crossover trial. P J Vuillermin, C F Robertson, J B Carlin, S L Brennan, M I Biscan, and M South. Correspondence to P J Vuillermin: [email protected]

Category: R. Respiratory. Keywords: asthma, acute asthma, asthma exacerbation, oral steroid therapy, parent-initiated therapy, randomized controlled trial, journal watch.
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 23 March 2010

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