Asthma is swelling in the airways (tubes) that lead to the lungs. The swelling decreases the amount of air that can be moved in and out of the lungs. It can be minor, with little interference with everyday activity, or it can be severe enough to completely cut off the air supply. Asthma treatments include identifying and avoiding asthma triggers and treating asthma flare-ups or episodes. The goal is to decrease the amount asthma interferes with physical activity and avoid severe episodes that require medical attention. Oral corticosteroids are very effective for treating asthma, but due to their many side effects, they are only used for a short time during severe episodes. Most often, they are prescribed after a medical professional has seen the child and decides that they are appropriate.
Researchers in Australia wanted to examine the benefits of a parent-initiated treatment for acute asthma attacks with prednisolone, a corticosteroid. The study, published in British Medical Journal, found that the parent program decreased asthma symptoms, school absences, and the need for medical care.
The randomized trial included 230 children ages 5-12 who had at least four asthma attacks in the last year. The children were randomized to receive parent-initiated prednisolone or placebo treatments when an asthma attack was developing. The parents were given educational information about when to offer the medicine. The treatment was recommended if an attack seemed more severe than usual or if symptoms were lasting more than 6 hours despite other treatment.
During the trial time, there were 308 asthma attacks. Compared to those who received placebo, children who were given prednisolone by their parent had:
Randomized trials are considered one of the most reliable types of studies. This study supports the idea that well informed parents may be able to make the decision about when to give their children an oral corticosteroid. However, there are still some questions before this becomes standard practice. High amounts of corticosteroids like prednisolone do have side effects in children, including decreased bone strength and growth. This study did not focus on any of these adverse health effects. For that reason, some may be hesitant to allow non-medical professionals to determine when a corticosteroid should be used. On the other hand, these corticosteroids are most effective when delivered early in an asthma attack. The ability to deliver the medicine at home can help prevent a delay in treatment. As with any chronic disease, it is also financially and practically more reasonable to decrease the need for medical reliance.
The first step for good asthma management is to prevent asthma attacks. Work with your doctor to develop an asthma management plan and continue to discuss what is working and what may need to be changed. Keep your child active in this plan. Learn about triggers like allergens (pet dander, chemicals, pollen, dust), get appropriate vaccinations, and follow an asthma care plan that includes long-term and fast-acting asthma medicine. Not all asthma attacks can be prevented, so make sure you have a plan for an attack. Keep rescue medicine nearby, and seek medical help if symptoms are not relieved by rescue medicines.
American Academy of Allergy, Asthma, & Immunology
Asthma and Allergy Foundation of America
National Heart Lung and Blood Institute
Vuillermin PJ, Robertson CF, Carlin JB, et al. Parent initiated prednisolone for acute asthma in children of school age: randomised controlled crossover trial.BMJ. 2010 Mar 1;340:c843.
Last reviewed 4/28/2010 by Brian P. Randall, MD