255 Parent-Initiated Oral Prednisolone for Episodes of Acute Asthma in Children Aged 5-13 Years

Background: There is high-level evidence that oral corticosteroids are effective in the treatment of acute asthma in school-aged children when administered following physician review. However, existing data regarding the effectiveness of parent-initiated oral corticosteroids for acute asthma in children is both disappointing and inadequate. We therefore aimed to assess the efficacy of a short course of parent-initiated oral prednisolone for acute asthma in school-aged children. Methods: We used a population-based sampling strategy to recruit children aged 5-12 years who had suffered four or more episodes of acute asthma in the preceding year. Episodes of acute asthma (rather than participants) were randomised to be treated with a 3-5 day course of parent-initiated prednisolone (1mg/kg) or placebo. The primary outcomes were a 7-day daytime symptom score and health resource utilization (HRU). Results: 230 children were enrolled in the study. Over a 3 year period 131 participants contributed 155 episodes of acute asthma randomised to parent-initiated treatment with prednisolone and 153 episodes treated with placebo. The mean daytime symptom score was on average 15% (95% CI 2% to 26%, p=0.022) lower among episodes treated with prednisolone. Concordantly, 48 (31%) of episodes treated with prednisolone resulted in HRU compared with 69 (45%) of episodes treated with placebo (odds ratio = 0.54, 95% CI 0.34 to 0.86, p=0.010). Conclusions: We found that a short course of oral prednisolone initiated by parents when their child suffers an episode of acute asthma resulted in a modest reduction in asthma symptoms and HRU.