Asthma prevalence in Melbourne schoolchildren: have we reached the peak? Acute asthma. Single dose oral steroids in paediatric community clinics Nebulized dexamethasone versus oral prednisone in the emergency treatment of asthmatic children. Oral corticosteroids for wheezing attacks under 18 months. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. Independent parental administration of prednisone in acute asthma: a double-blind, placebo-controlled, crossover study. Recurrent wheezy bronchitis and viral respiratory infections. Reported versus confirmed wheeze and lung function in early life Symptomatic improvement following emergency department management of asthma: a pilot study of intramuscular dexamethasone versus oral prednisone. Efficacy of a short course of parent-initiated oral prednisolone for viral wheeze in children aged 1–5 years: randomised controlled trial Early intervention with short courses of prednisone to prevent progression of asthma in ambulatory patients incompletely responsive to bronchodilators. A single dose of intramuscularly administered dexamethasone acetate is as effective as oral prednisone to treat asthma exacerbations in young children. Adverse behavioral effects of treatment for acute exacerbation of asthma in children: a comparison of two doses of oral steroids. Controlled trial of oral prednisone in the emergency department treatment of children with acute asthma. Comparative efficacy of oral dexamethasone versus oral prednisone in acute pediatric asthma. Are all wheezing disorders in very young (preschool) children increasing in prevalence?
OBJECTIVE To determine the change in prevalence of  asthma , eczema and allergic rhinitis in Australian schoolchildren between 1993 and 2002 . DESIGN Question naire based survey , using the protocol of the International Study of Asthma and Allergy in Childhood . SETTING Metropolitan Melbourne primary schools within a 20 km radius of the GPO in 1993 and 2002 . SUBJECTS All children in school years 1 and 2 ( ages 6 and 7 ) attending a r and om sample of 84 schools in 1993 and 63 schools in 2002 . MAIN OUTCOME MEASURES Parent-reported symptoms of atopic disease ; treatment for asthma ; country of birth . RESULTS There was a 26 % reduction in the 12-month period prevalence of reported wheeze , from 27.2 % in 1993 to 20.0 % in 2002 . The magnitude of reduction was similar for boys ( 27 % ) and girls ( 25 % ) . The 12-month period prevalence of reported eczema increased from 11.1 % in 1993 to 17.2 % in 2002 , and rhinitis increased from 9.7 % to 12.7 % . There were reductions in the proportion of children attending an emergency department for asthma in the previous year ( 3.6 % to 2.3 % ) , the proportion admitted to hospital ( 1.7 % to 1.1 % ) and the proportion taking asthma medication ( 18.5 % to 13.4 % ) . Of those who reported frequent wheeze , there was an increase in the proportion taking regular inhaled steroids ( 34.5 % to 40.9 % ) . CONCLUSION There has been a significant reduction in the prevalence of reported asthma in Melbourne schoolchildren , whereas the prevalence of eczema and allergic rhinitis has continued to increase The treatment of an acute asthma attack usually includes bronchodilators and often steroids . We studied 70 children who were r and omly assigned to receive either single dose steroids ( oral prednisone : 20–40 mg ) or placebo on a double blind basis . The time course of the observation was 72 h. We demonstrate that a single dose of steroids , given orally in paediatric community clinics during an acute mild to moderate asthma attack , significantly improves the patient 's course ; deterioration was prevented , symptoms were relieved faster , and hospitalization was not required . We encourage paediatricians in the ambulatory clinics to follow this treatment modality and to give , in addition to other conventional therapy , a single oral dose of steroids early in the asthma attack , in order to relieve and shorten the child 's distress STUDY OBJECTIVE To compare nebulized dexamethasone with oral prednisone in the treatment of children with asthma . DESIGN A r and omized , double-blind , double-placebo study . SETTING An urban pediatric emergency department . PARTICIPANTS Patients aged 1 to 17 years with acute asthma . INTERVENTIONS Patients with moderate asthma exacerbation received frequent aerosolized albuterol and either 1.5 mg/kg of nebulized dexamethasone or 2 mg/kg of oral prednisone . RESULTS A total of 111 children was evaluated ; 21 % of those treated with dexamethasone required hospitalization , compared with 31 % of those treated with prednisone ( P = .26 ) . A significantly greater proportion of dexamethasone-treated children were discharged home within 2 hours ( 23 % versus 7 % , P = .02 ) . In the dexamethasone group , 8 % who received the drug by mouthpiece were hospitalized compared with 33 % who received it by face mask ( P = .06 ) . Fewer children treated with dexamethasone  vomited ( 0 % versus 15 % , P = .001 ) and fewer relapsed within 48 hours of ED discharge ( 0 % versus 16 % , P = .008 ) . CONCLUSION Nebulized dexamethasone was as effective as oral prednisone in the ED treatment of moderately ill children with acute asthma and was associated with more rapid clinical improvement , more reliable drug delivery , and fewer relapses In a double blind , partial crossover trial we compared treatment with prednisolone with treatment with placebo ( 56 treatments ) in 38 children aged less than 18 months ( mean age 9.8 months , range 3 - 17 months ) , 30 of whom had required previous admission to hospital .  Placebo or oral prednisolone 2 mg/kg/day in two divided doses for five days was given during acute exacerbations of symptoms on an outpatient basis . Daily symptom scores of cough , wheeze , and breathlessness did not show any significant difference in rate of improvement or overall outcome , either between the two whole groups or within subgroups aged less than 6 months , 6 - 12 months , and 12 - 18 months . Parental preference failed to indicate superiority of treatment with prednisolone over treatment with placebo in the 18 crossover patients , and parents were equally as likely to feel that treatment with either placebo or prednisolone had had positive effect in non-crossover patients . Two children required admission to hospital during treatment , one aged 5 1/2 months being treated with prednisolone , and one aged 14 months being treated with placebo BACKGROUND Many young children wheeze during viral respiratory infections , but the pathogenesis of these episodes and their relation to the development of asthma later in life are not well understood . METHODS In a prospect i ve study , we investigated the factors affecting wheezing before the age of three years and their relation to wheezing at six years of age . Of 1246 newborns in the Tucson , Arizona , area enrolled between May 1980 and October 1984 , follow-up data at both three and six years of age was available for 826 . For these children , assessment s in infancy included measurement of cord-serum IgE levels  ( measured in 750 children ) , pulmonary-function testing before any lower respiratory illness had occurred ( 125 ) , measurement of serum IgE levels at nine months of age ( 672 ) , and question naires completed by the children 's parents when the children were one year old ( 800 ) . Assessment s at six years of age included measurement of serum IgE levels  ( in 460 ) ,  pulmonary-function testing  ( 526 ) , and  skin allergy testing  ( 629 ) . RESULTS At the age of six years , 425 children ( 51.5 percent ) had never wheezed , 164 ( 19.9 percent ) had had at least one lower respiratory illness with wheezing during the first three years of life but had no  wheezing at six years of age , 124 ( 15.0 percent ) had no  wheezing  before the age of three years but had wheezing at the age of six years , and 113 ( 13.7 percent ) had wheezing both before three years of age and at six years of age . The children who had wheezing before three years of age but not at the age of six had diminished airway function ( length-adjusted maximal expiratory flow at functional residual capacity [ Vmax FRC ] ) both before the age of one year and at the age of six years , were more likely than the other children to have mothers who smoked but not mothers with asthma , and did not have elevated serum IgE levels or skin-test reactivity . Children who started wheezing in early life and continued to wheeze at the age of six were more likely than the children who never wheezed to have mothers with a history of asthma ( P < 0.001 ) , to have elevated serum IgE levels ( P < 0.01 ) , to have normal lung function in the first year of life , and to have elevated serum IgE levels ( P < 0.001 ) and diminished values for VmaxFRC ( P < 0.01 ) at six years of age . CONCLUSIONS The majority of infants with wheezing have transient conditions associated with diminished airway function at birth and do not have increased risks of asthma or allergies later in life . In a substantial minority of infants , however , wheezing episodes are probably related to a predisposition to asthma OBJECTIVE To determine the effectiveness of a single dose of prednisone administered by a parent to a child early in an asthma attack . DESIGN A r and omized , double-blind , placebo-controlled , crossover study with children enrolled for 12 months ( 6 months prednisone , 6 months placebo ) . SETTING A primary -care clinic and emergency department of an inner-city teaching hospital from March 1992 through May 1993 . CHILDREN Children 2 to 14 years of age enrolled in this clinic who had made two or more outpatient ( emergency department or primary -care clinic ) visits for acute asthma in the preceding year . SELECTION There were 204 eligible children , of whom 86 were contacted and enrolled ; of these , 78 ( 91 % ) completed the study . INTERVENTION Capsules containing prednisone ( 2 mg/kg up to 60 mg ) or placebo . Parents were instructed to give their child one capsule for an asthma attack that had not improved after a dose of the child 's regular acute asthma medicine . MEASUREMENTS Parents were interviewed every 3 months . Computerized patient records and chart review s were used to verify parent reports . Outcome measures were the numbers of outpatient visits and hospitalizations for treatment of acute asthma . RESULTS Neither the total number of attacks nor the number for which medicine was used differed significantly by arm of study . There was a larger number of attacks result ing in outpatient visits when children were in the group that received prednisone ( 1.1 + /- 0.59 versus 0.59 + /- 0.86 ) . This trend was less pronounced but persisted when limited to attacks for which the medicine was given ( 0.58 + /- 0.99 versus 0.35 + /- 0.55 ) . Neither the number of attacks result ing in admission nor the number of hospital days differed significantly by arm of study . CONCLUSIONS A single dose of prednisone available for use at home early in an asthma attack was associated with an increase in outpatient visits made for acute asthma . When prednisone was given for an attack , there was no reduction in outpatient visits . This intervention can not be recommended for children with asthma . These results should be confirmed in other pediatric population Fifty four patients aged from 1 to 6 years who had had recurrent attacks of wheezy bronchitis were prospect ively followed up for three months to find out if there was an association between different viral respiratory infections and episodes of wheezing . Of the 115 episodes of upper or lower respiratory tract symptoms , virus or Mycoplasma pneumoniae infection were diagnosed in 52 ( 45 % ) . Thirty four of rhinoviruses . The patients had an average of 2.1 episodes of respiratory tract symptoms the total mean ( SD ) duration of which was 30 ( 2 ) days of the 92 days that followed . Wheezing occurred during 76 ( 66 % ) of the 115 episodes and during a third of these the patient was admitted to hospital because of severe dyspnoea . Wheezing started a mean ( SD ) of 43 ( 7 ) hours after the first symptoms of respiratory infection and persisted for 3.8 ( 4.2 ) days in patients in whom virus infection was diagnosed . The incidence of wheezing was not associated with IgE mediated atopy , with positive virological tests , or with fever during virus infection , but was associated with parental smoking and more than one sibling Aims : To investigate the relation between parentally  reported wheeze ( unconfirmed ) , physician confirmed wheeze , and subsequent lung function . Methods : Children at risk of allergic disease ( one parent atopic ) were recruited antenatally and followed prospect ively from birth . During the first three years of life parents were asked to contact the study team if their child was wheezy . The presence of wheeze was confirmed or not by the primary care or study physician .  Respiratory question naire and specific airway resistance measurement ( sRaw , body plethysmograph )  were completed at age 3 years . Results : A total of 454 children were followed from birth to 3 years of age . One hundred and eighty six ( 40.9 % ) of the parents reported their child wheezing in the first three years of life , and in 130 ( 28.6 % ) the wheeze was confirmed . A total of 428 children attended the three year clinic review , of whom 274 ( 64 % ) successfully carried out lung function tests . There was no significant difference in sRaw ( kPa·s ; geometric mean , 95 % CI ) between children who had never wheezed ( n = 152 ; 1.03 , 1.00 to 1.06 ) and those with a parentally reported but unconfirmed wheeze ( n = 36 ; 1.02 , 0.96 to 1.07 , p = 1.00 ) . sRaw was significantly higher in children with a physician confirmed wheeze ( n = 86 ; 1.17 , 1.11 to 1.22 , p < 0.001 ) compared to those with no history of wheeze or with unconfirmed wheeze . Conclusions : Children with physician confirmed wheeze  have significantly poorer lung function compared to those with parentally reported but unconfirmed and those who have never wheezed . A proportion of parents may have little underst and ing of what medical professionals mean by the term “ wheeze ” Systemic corticosteroid therapy is an established adjunct to beta-adrenergic medications in acute exacerbations of asthma . To date , no study has defined the role of long-acting intramuscular preparations of corticosteroids in pediatric patients with asthma . A pilot study was conducted to prospect ively compare symptomatic improvement following a single injection of intramuscular dexamethasone ( IMD ) to a 3-day regimen of oral prednisone ( OP ) for children with mild to moderate wheezing episodes that are responsive to nebulized medications in the Pediatric Emergency Department ( PED ) . The following children presenting with acute exacerbations of asthma to the PED were eligible for enrollment : age 3 - 16 years ; more than two prior wheezing episodes ; mild to moderate wheezing ; and oxygen saturation 95 % or more in room air . The study patients were r and omly assigned to receive either IMD ( n = 21 ) or OP ( n = 21 ) in addition to a st and ardized treatment regimen of nebulized albuterol . All of the children were clinical ly rated for wheezing severity by the Pulmonary Index ( PI ) score at regular intervals during the study . Discharge home was based on clinical improvement during treatment in the PED ; patients who were admitted to the hospital were removed from the study . Follow-up was conducted the fifth day after discharge from the ED either by clinic visit or by telephone . Patients were assessed for symptomatic improvement and relapse or clinical deterioration during the study period by a clinician blinded to group assignment . Forty-two children participated in this pilot study . There were no significant differences between the IMD and OP groups for gender or age . Mean ages were : 82 months ( SD 46 months ) , IMD group ; 63 months ( SD 36 months ) , OP group . Clinical progress ( based on PI ) with treatment in the PED was the same in both groups : pretreatment median , PI = 6 ; PED discharge median , PI = 2 . None of the study patients were hospitalized during the follow-up period , and all reported symptomatic improvement since initial treatment . The data of this pilot study suggest that IMD may be a feasible alternative to OP for treatment of acute wheezing episodes in children with asthma . IMD provides sufficient treatment to prevent clinical deterioration within 5 days after initial therapy for mild to moderate pediatric exacerbations of asthma that are responsive to nebulized medications BACKGROUND Episodic wheeze triggered by viral colds is common in children aged between 1 and 5 years ( preschool viral wheeze ) . Most affected children are asymptomatic by age 6 years . Persistence of wheeze is associated with above-average systemic eosinophil priming . Use of parental-initiated oral prednisolone is recommended at the first sign of preschool viral wheeze . However , evidence for this treatment strategy is conflicting . We therefore aim ed to assess the efficacy of a short course of oral prednisolone for preschool viral wheeze , with stratification for systemic eosinophil priming . METHODS Children aged 1 - 5 years admitted to hospital with viral wheeze were allocated to either a high-primed or low-primed stratum according to amounts of serum eosinophil cationic protein and eosinophil protein X , and r and omised to parent-initiated prednisolone ( 20 mg one daily for 5 days ) or placebo for the next episode . The primary outcomes were the 7-day mean daytime and night-time respiratory symptom scores , which were analysed by mean differences between treatment groups . FINDINGS 108 children were r and omised to placebo and 109 to prednisolone . Outcome data were available for 120 ( 78 % ) of 153 children who had a further episode of viral wheeze , of whom 51 received prednisolone and 69 placebo .  Mean daytime ( difference in means -0.01 [ -0.22 to 0.20 ] ) and night-time ( 0.10 [ -0.12 to 0.32 ] ) respiratory symptom scores and need for hospital admission did not differ between treatment groups . Within the high-primed ( n=59 ) and low-primed ( n=61 ) strata there was no difference in primary outcome between treatment groups . INTERPRETATION There is no clear benefit of a short course of parent-initiated oral prednisolone for viral wheeze in children aged 1 - 5 years even in those with above-average eosinophil priming The effect of high orally administered doses of prednisone for 1 week early in the course of an acute exacerbation of asthma incompletely responsive to bronchodilators was examined in 41 patients r and omly assigned to receive either prednisone or an identical appearing placebo .  All 22 of the patients who received prednisone improved during the week of treatment , although one had a subsequent exacerbation 5 days after discontinuing the study medication . Of the 19 who received placebo , eight required rescue intervention ( P = less than 0.004 ) in association with continued symptoms , increased frequency of metered-dose inhaler use , and decreased pulmonary function ; the other 11 improved at about the same rate as those who received prednisone . Although the mean initial FEV1 was suggestively lower among those who did not improve and required intervention , there was considerable overlap with those who improved spontaneously , and no reliable distinguishing characteristics were found at entry into the study that could serve as predictors of those who would or would not improve spontaneously . There were no clinical ly important adverse effects from the prednisone . Because continued symptoms of asthma often result in emergency care or hospitalization , these data support early intervention with orally administered prednisone for acute exacerbations that do not respond fully to bronchodilators , at least in those patients with a prior history of a protracted course or emergency care OBJECTIVE To evaluate whether a single dose of intramuscularly administered dexamethasone acetate ( IM Dex ) was as safe and effective as a 5-day course of oral prednisone ( PO Pred ) in the treatment of young children with mild-moderate exacerbations of asthma . STUDY DESIGN A prospect i ve , r and omized , investigator-blinded study was done in a tertiary care medical center in children ( 6 months to 7 years of age ) who required corticosteroids to treat mild-moderate asthma exacerbations as out patients . Patients were r and omized to receive either a single dose of IM Dex ( approximately 1.7 mg/kg ) or PO Pred ( approximately 2 mg/kg/d for 5 days ) . Clinical asthma score , behavioral changes , albuterol use , and tolerance of the medication were recorded in a home diary for 7 days . Cortisol/creatinine ratios on first morning void urine sample s were obtained on day 14 . The primary outcome measures were changes in clinical asthma score through day 5 and tolerance of the medication . RESULTS Fifteen patients in the IM Dex group ( mean age 37 months ) and 17 in the PO Pred group ( mean age 36 months ) completed the study . Clinical asthma score improved significantly in both groups during the first 5 days of therapy , and no significant difference was seen in the rate of improvement between the 2 groups . Three children refused more than 75 % of their prednisone doses , and another 4 missed 30 % to 50 % of the doses despite their parents ' best efforts . The intramuscular injection caused no complications , and approximately 70 % of parents in both groups stated that they would choose IM Dex to treat their child 's next asthma exacerbation . CONCLUSION In this group of children a single intramuscular injection of dexamethasone acetate was as effective as a 5-day course of PO Pred for the management of mild-moderate outpatient asthma exacerbations OBJECTIVE To determine the relative adverse symptomatic effects and benefits of therapy with oral corticosteroids at doses of 2 mg/kg vs 1 mg/kg daily in children with acute exacerbations of asthma . METHODS Using a question naire that addressed symptoms , we conducted a prospect i ve study of the adverse effects and benefits of therapy with prednisone or prednisolone at two dose levels in 86 children who were 2 to 16 years of age with mild persistent asthma during an acute exacerbation and were unresponsive to therapy with inhaled steroids and beta-adrenergic agents .  Parents and physicians were blinded to the dose level . Children were assigned to either of the two doses by r and om allocation . Behavioral side effects were assessed via a question naire administered by a physician . Benefits were measured by the resolution of asthma symptoms ( cough , shortness of breath , and wheeze ) at the completion of the treatment with oral steroids . RESULTS Behavioral side effects , particularly anxiety ( p < 0.02 ) and aggressive behavior ( p < 0.002 ) , were twice as common in patients receiving a dose of 2 mg/kg/d . Benefits were comparable in the two groups . The number needed to harm ( ie , the number of patients receiving experimental treatment that would lead to one additional person being harmed vs patients receiving st and ard treatment ) was 6.1 for anxiety , 8.6 for hyperactivity , and 4.8 for aggressive behavior . CONCLUSIONS Because the adverse side effects were greater at the higher dose but the benefits were comparable , we recommend using an oral corticosteroid dose of 1 mg/kg daily for children with mild persistent asthma who present with an acute exacerbation of asthma BACKGROUND Recent studies have shown that the use of parenteral corticosteroids in the emergency department decreases the hospitalization rate for patients with acute asthma . We studied the efficacy of oral corticosteroids in the emergency department treatment of moderately ill children with acute asthma . METHODS Emergency department patients aged 1 through 17 years whose chief complaint was acute asthma were assigned a pulmonary index , based on clinical evaluation . Those with a moderate exacerbation ( pulmonary index = 9 through 13 ) received either 2 mg/kg of oral prednisone or placebo in a r and omized , double-blind fashion . Patients in each group were then treated with an identical regimen of frequent aerosolized albuterol , for up to a maximum of 4 hours . RESULTS Seventy-five patients were assessed . Overall , 11 ( 31 % ) of 36 in the prednisone group required hospitalization compared with 19 ( 49 % ) of 39 in the placebo group ( P = .10 ) . Among the sickest patients ( initial pulmonary index > 10 ) , 7 ( 32 % ) of 22 prednisone-treated patients required hospitalization compared with 13 ( 72 % ) of 18 placebo-treated patients ( P < .05 ) . Among patients who had a suboptimal response to initial beta 2-agonist therapy and who therefore would have been hospitalized had treatment been restricted to 2 hours , 9 ( 45 % ) of 20 in the prednisone group ultimately required hospitalization when duration of care was extended 2 additional hours compared with 15 ( 83 % ) of 18 in the placebo group ( P < .05 ) . In addition , prednisone-treated patients had a significantly greater improvement in median pulmonary index ( 5.0 vs 3.0 , P < .001 ) . CONCLUSIONS These data demonstrate that oral prednisone , within 4 hours of its administration , reduced the need for hospitalization among a subset of children treated in the emergency department for acute asthma OBJECTIVE The objective was to determine whether 2 days of oral dexamethasone ( DEX ) is more effective than 5 days of oral prednisone/prednisolone ( PRED ) in improving symptoms and preventing relapse in children with acute asthma . STUDY DESIGN This was a prospect i ve r and omized trial of children ( 2 to 18 years old ) who presented to the emergency department with acute asthma .  PRED 2 mg/kg , maximum 60 mg ( odd days ) or DEX 0.6 mg/kg , maximum 16 mg ( even days ) was used . At discharge children in the PRED group were prescribed 4 daily doses ( 1 mg/kg/d , maximum 60 mg ) ; children in the DEX group received a prepackaged dose ( 0.6 mg/kg , maximum 16 mg ) to take the next  day . The primary outcome was relapse within 10 days . RESULTS When DEX was compared with PRED , relapse rates ( 7.4 % of 272 vs 6.9 % of 261 ) , hospitalization rates from the emergency department ( 11 % vs 12 % ) or after relapse ( 20 % vs 17 % ) , and symptom persistence at 10 days ( 22 % vs 21 % ) were similar . In the PRED group more children were excluded for vomiting in the emergency department ( 3 % vs 0.3 % ; P = .008 ) , more parents were noncompliant ( 4 % vs. 0.4 % ; P = .004 ) , and more children missed > or = 2 days of school ( 19.5 % vs. 13.2 % ; P = .05 ) . CONCLUSION In children with acute asthma , 2 doses of dexamethasone provide similar efficacy with improved compliance and fewer side effects than 5 doses of prednisone BACKGROUND Distinct wheezing disorders co-exist in young ( preschool ) children , some of which ( early transient wheeze and viral wheeze ) are thought to be unrelated to atopy . Investigation of changes in prevalence of wheezing disorders in preschool children could provide important clues about underlying mechanisms responsible for increasing prevalence of asthma in schoolchildren . METHODS Repeated population surveys of the prevalence of respiratory symptoms were done by parent-completed postal question naires in r and om sample s of 1650 ( 1990 ) and 2600 ( 1998 ) caucasian children aged 1 - 5 years living in the county of Leicestershire , UK . FINDINGS The response rates were 86 % ( 1422 of 1650 ) in 1990 and 84 % ( 2127 of 2522 ) in 1998 . Between 1990 and 1998 , there was a significant increase in the prevalance of reported wheeze ever ( 16 % to 29 % , p<0.0001 ) , current wheeze ( 12 % to 26 % , p<0.0001 ) , diagnosis of asthma ( 11 % to 19 % , p<0.0001 ) , treatment for wheeze ( 15 % to 26 % , p<0.0001 ) , and admission for wheeze or other chest trouble ( 6 % to 10 % , p<0.0001 ) . The increase occurred both in children with viral wheeze ( 9 % to 19 % ) and in those with the classic asthma pattern of wheezing with multiple triggers ( 6 % to 10 % ) . There was also an increase in transient early wheezers ( 3 % to 5 % ) , persistent wheezers ( 5 % to 13 % ) , and late-onset wheezers ( 6 % to 8 % ) , and in all severity groups . The increase could not be accounted for by putative household risk factors because these declined between the 2 years . INTERPRETATION The fact that all preschool wheezing disorders increased ( including viral wheeze ) makes it probable that factors unrelated to atopy are implicated in the changing epidemiology of wheeze in childhood
BACKGROUND Intermittent wheezing illnesses , which include viral associated wheeze and asthma , are amongst the most common reasons for children to present urgently to a doctor .
Whether parents should commence oral corticosteroids ( OCS ) for an episode of acute wheeze in their child without waiting for a medical review is an important question , as the potential benefits of early oral corticosteroid intervention have to be weighed against the potential adverse effects of treatment .
OBJECTIVES The objectives were to assess the benefits and harmful effects of parent-initiated OCS , in the management of intermittent wheezing illnesses in children , based on the results of r and omised clinical trials .