Post on 02-Jun-2018
8/10/2019 Reading Medical Journal Asthma
1/16
Reading medical journal asthma
Fannia Debora S
8/10/2019 Reading Medical Journal Asthma
2/16
Title and abstract
Parent initiated prednisolone for acute asthma
in children of school age: randomised
controlled crossover trial
8/10/2019 Reading Medical Journal Asthma
3/16
Introduction :
background
There is high level evidence that oral
corticosteroids are effective in the treatment
of acute asthma in children of school age.
However , cortical steroid have many negative
side effect
8/10/2019 Reading Medical Journal Asthma
4/16
What is the existing state of knowledgeon prednisolone?
There is high level evidence that oral corticosteroids areeffective in the treatment of acute asthma in children ofschool age when administered after the child has been
assessed by a doctor. Many of the benefits of oralcorticosteroids have been shown to begin within three hoursof administration, and delayed dosing is less effectiveatresolving acute asthma.
Parent initiated treatment with oral corticosteroids seems to
be ineffective among preschool children with so called viralinduced wheeze,and the European Respiratory Societyrecently advised against parent initiated oral corticosteroidsin children of preschool age with recurrent wheeze
Oral kortikosteroid bny digunakan untuk pasien anak dg kasus
asma,
8/10/2019 Reading Medical Journal Asthma
5/16
What is the gap in knowledge that the study willfill?
Existing evidenceregarding parent initiated oral
corticosteroids in school age children withasthma is inadequate, and the role of parentinitiation of oral corticosteroids is not clarifiedininternational asthma management guidelines.
Bukti ttg keefektifan oral corticosteroids pd anakkurang dan tidak jelas tercantum pd guiline asmainternasional
8/10/2019 Reading Medical Journal Asthma
6/16
What did the author intend to do?
We undertook a double blind, randomised,
crossover trial to determine the effectiveness
of parent initiated oral prednisolone
compared with placebo in children of primary
school age who experience recurrent episodes
of acute asthma.
8/10/2019 Reading Medical Journal Asthma
7/16
The problem
Existing evidence regarding parent initiated
oral corticosteroids in school age children with
asthma is inadequate,
and the role of parent initiation of oral
corticosteroids is not clarified in international
asthma management guidelines.
8/10/2019 Reading Medical Journal Asthma
8/16
methods
Participants
Inclution :
Children aged 5 to 12 years who had experienced
four or more episodes of acute asthma requiringat least 24 hours of bronchodilator therapy in thepreceding 12 months were eligible to participate,regardless of the presence or absence of asthmainterval symptoms.
Exclution :
8/10/2019 Reading Medical Journal Asthma
9/16
intervention
A short course of parent initiated treatment
with prednisolone (1 mg/kg a day) or placebo.
Participants were randomly assigned to one of
four sequences of study medication (ABAB,
ABBA, BAAB, or BABA, where A=prednisolone
and B=placebo).
8/10/2019 Reading Medical Journal Asthma
10/16
objective
To evaluate the efficacy of a short course of
parent initiated oral prednisolone for acute
asthma in children of school age.
8/10/2019 Reading Medical Journal Asthma
11/16
outcome
8/10/2019 Reading Medical Journal Asthma
12/16
Sample size
230 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.
l
8/10/2019 Reading Medical Journal Asthma
13/16
result
8/10/2019 Reading Medical Journal Asthma
14/16
baseline
8/10/2019 Reading Medical Journal Asthma
15/16
Discussion (+ side)
Several aspects of the methodology of this trialwere novel.
Our recruitment strategy was also novel.
The strategy of randomly allocating episodes ofacute asthma rather than participants was alsoeffective because the within participant datareduced the diluting effect of between
participant variation in asthma phenotype,symptom interpretation, and threshold for healthresource use.
8/10/2019 Reading Medical Journal Asthma
16/16
Discussion (-side)
However, the
modest benefits of this strategy must be
balanced against potential side effects of
repeated short courses of an oral
corticosteroid.