• P J Vuillermin, C F Robertson, J B Carlin, S L Brennan, M I Biscan, and M South.
• Geelong Hospital, Barwon Health, Geelong 3220, Australia. peterv@barwonhealth.org.au
• BMJ. 2010 Jan 1; 340: c843.

ObjectiveTo evaluate the efficacy of a short course of parent initiated oral prednisolone for acute asthma in children of school age.DesignDouble blind, randomised, placebo controlled, crossover trial in which episodes of asthma, rather than participants, were randomised to treatment.SettingThe Barwon region of Victoria, Australia.ParticipantsChildren aged 5-12 years with a history of recurrent episodes of acute asthma.InterventionA short course of parent initiated treatment with prednisolone (1 mg/kg a day) or placebo.Main Outcome MeasuresThe 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.Results230 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).ConclusionA 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 RegistrationISRCTN 26232583.

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