reading medical journal asthma

8/10/2019 Reading Medical Journal Asthma

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Reading medical journal asthma

Fannia Debora S


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Title and abstract

Parent initiated prednisolone for acute asthma

in children of school age: randomised

controlled crossover trial


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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


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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,


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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


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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.


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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.


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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 :


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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).


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objective

To evaluate the efficacy of a short course of

parent initiated oral prednisolone for acute

asthma in children of school age.


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outcome


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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


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result


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baseline


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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.


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Discussion (-side)

However, the

modest benefits of this strategy must be

balanced against potential side effects of

repeated short courses of an oral

corticosteroid.

reading medical journal asthma

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