Editorials

Acute asthma in children of school age

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c988 (Published 01 March 2010) Cite this as: BMJ 2010;340:c988
  1. Duncan Keeley, general practitioner
  1. 1Rycote Practice, Thame, Oxon OX9 3JZ
  1. duncan.keeley{at}nhs.net

    Parent initiated prednisolone is beneficial but the effect is small

    Asthma is one of the most common chronic diseases in childhood. Despite improvements in management it is still responsible for around 32 000 hospital admissions and 40 deaths annually in children in the United Kingdom.1 Evidence for the effectiveness of guided self management in improving treatment outcomes is extensive,2 but the contribution of the various components of asthma self management programmes is less clear. Parent initiated treatment of exacerbations with prednisolone is often included in self management plans for children, but evidence for this treatment has been inferred from the confirmed effectiveness of oral corticosteroids in children admitted to hospital with asthma.3

    In the linked randomised controlled trial (doi:10.1136/bmj.c843), Vuillermin and colleagues assess this strategy in children of school age and find that prednisolone produces small but definite improvements in symptom scores, reductions in health service usage (number needed to treat 7), and a possible reduction in hospital admissions (NNT 25 with a wide confidence interval).4 So prednisolone helps, but the effect size in this population was small and has to be balanced against the possible harms of repeated courses of oral corticosteroids.

    The study is an excellent example of filling a gap in the evidence base for commonly used interventions. The need for the …

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