A 5‐ versus 3‐day course of oral corticosteroids for children with asthma exacerbations who are not hospitalised: a randomised controlled trial

Abstract

Objective: To determine whether a 5‐day course of oral prednisolone is superior to a 3‐day course in reducing the 2‐week morbidity of children with asthma exacerbations who are not hospitalised. Design, setting and participants: Double‐blind randomised controlled trial of asthma outcomes following a 5‐day course of oral prednisolone (1 mg/kg) compared with a 3‐day course of prednisolone plus placebo for 2 days. Participants were children aged 2–15 years who presented to the emergency departments of three Queensland hospitals between March 2004 and February 2007 with an acute exacerbation of asthma, but were not hospitalised. Sample size was defined a priori for a study power of 90%. Main outcome measures: Difference in proportion of children who were symptom‐free at Day 7, as measured by intention‐to‐treat (ITT) and per‐protocol analysis; quality of life (QOL) on Days 7 and 14. Results: 201 children were enrolled, and there was an 82% completion rate. There was no difference between groups in the proportion of children who were symptom‐free (observed difference, 0.04 [95% CI, − 0.09 to 0.18] by ITT analysis; 0.04 [95% CI, − 0.17 to 0.09] by per‐protocol analysis). There was also no difference between groups in QOL (P = 0.42). The difference between groups for the primary outcome was within the equivalence range calculated post priori. Conclusion: A 5‐day course of oral prednisolone confers no advantage over a 3‐day course for children with asthma exacerbations who are not hospitalised. Trial registration: Australian Clinical Trials Registry ACTRN012605000305628.

Management based on exhaled nitric oxide levels adjusted for atopy reduces asthma exacerbations in children: A dual centre randomized controlled trial

“…Hence, we considered children were well controlled if their total weekly score was <10. Our previous paper on asthma had also similar results with respect to the scores when well. For the 15% change representing instability, this was based on 1.96 times the standard deviation of the median change in the children with unstable asthma, as described by the authors of the asthma diary scale in their paper for discriminant validity between stable and unstable children …”

COPD exacerbations in general practice: variability in oral prednisolone courses

“…In patients with a COPD exacerbation, treatment should be as short as possible with the dosage prednisolone as low as possible. In patients with an asthma exacerbation a short course (3-5 days) of prednisolone has been shown to be effective [28,29]. …”

To the editor

“…It would be ideal that liver biopsy is included as a routine procedure during the operation and complement with the fi nal diagnosis. [4,5] Author reply W e thank Dr. Yeh and Chang for their valuable comments on our paper. We agree with their view points, which are complementary to our study.…”

“…[4] In a recent trial, 3-day treatment was as effective as 5-day treatment in children aged 2-15 years. [5] The 3-day treatment can also be used in children aged below 2 years. [3] Weaning is unnecessary unless the duration exceeds 14 days.…”