TY - JOUR T1 - Journal scan JF - Journal of Accident & Emergency Medicine JO - Arch Emerg Med SP - 50 LP - 52 DO - 10.1136/emj.17.1.50 VL - 17 IS - 1 AU - Jim Wardrope AU - John Richards Y1 - 2000/01/01 UR - http://emj.bmj.com/content/17/1/50.abstract N2 - Edited by Jim Wardrope; this scan coordinated by John Richards B Rowe, G Bota, L Fabris, et alJAMA1999;281:2119–26 Aims—To determine whether the addition of inhaled corticosteroids to oral corticosteroid treatment reduces relapses in acute asthma patients treated and discharged from the emergency department. Design and setting—Prospective, randomised, placebo controlled, double blinded clinical trial, in a community hospital emergency department in Canada. Patients and methods—Patients between the ages of 16 and 60 years with a clinical diagnosis of acute asthma considered suitable for home discharge were referred for assessment for enrolment. Enrolled patients were randomly assigned in a double blinded fashion to either the treatment group (inhaled budesonide two puffs twice a day for 21 days), or to the control group (identical placebo two puffs twice a day for 21 days). All patients were discharged with a non-tapering course of oral prednisolone. Patients were followed up until relapse or for 21 days. Exclusion criteria included recent oral or inhaled corticosteroid treatment, complicating comorbid medical illnesses, pregnancy, breast feeding, attending for repeat scripts, geographically inaccessible, language/communication problems, first diagnosis of asthma, already enrolled in the study, pretreatment peak expiratory flow >80% of predicted for age, sex, height. Outcome measures—Primary outcome measured was incidence of relapse within 21 days, defined as an unscheduled visit for worsening asthma symptoms. Secondary outcomes measured included responses to an asthma quality of life questionnaire, frequency of β2 agonist use in the previous 24 hour period, symptom scoring by patients, global improvement assessment by patients, and pulmonary function testing of patients. Analysis—Primary analyses were based on an intention to treat principle. Time to relapse was analysed using a Kaplan-Meier survival curve and the log rank test. Baseline patient variations (age, sex, severity) were adjusted for using logistic regression. The secondary analyses used t tests for continuous, normally distributed results and … ER -