Budesonide Nebulization Added to Systemic Prednisolone in the Treatment of Acute Asthma in Children: A Double-Blind, Randomized, Controlled Trial

statistical difference between the beclomethasone and placebo groups, there are several important caveats. In screening for this study, 1371 childrenwere seen and 846 children were excluded, mostly for wheezing at the baseline visit and corticosteroid use in the previous month. Had these children been seen a day earlier without wheezing, or a couple weeks later when they were “off” steroids, they may have qualified for the study; in addition, considering they may well have had increased bronchial hyperresponsiveness compared with some of the children in the study, this action may have accentuated the differences between beclomethasone and placebo. Although the conclusion of the study stands, it is important to note the strong trend in favor of beclomethasone, with a relative risk of 0.61 and the upper end of the 95% CI just eclipsing unity at 1.08 (associated with a P value of .09). A final point is that the study did not document when the child first exhibited signs of a viral upper respiratory tract infection. If the average child was not seen until day 3 (or even later), this delay in corticosteroid therapy could also bias the results to show minimal differences. In this regard, a useful follow-up study would be to repeat the protocol but only allow entrance in the first 24 to 48 hours of an upper respiratory tract infection; this early intervention wouldmimic what we currently tell our parents to do.