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Parental guidance ... may be unsuitable for younger children

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Education and self management fail to control asthma in preschool children, a new randomised control trial targeting parents has found. Current thinking that patients should be given information on self management to help reduce illness from asthma seems warranted according to trials of children over a wide age range (2–16 years). Stevens et al, however, report contradictory results from their prospective randomised, controlled trial in two UK centres of the effect of educating parents of preschool children about managing their child's asthma and providing a self management plan.

Over 13 months they recruited 200 children aged 18 months–5 years on admission to the children's ward or emergency department of either hospital with a primary diagnosis of asthma or wheeze. The intervention group received a booklet about asthma in preschool children, a written guided self management plan, and two educational sessions with a specialist respiratory nurse; the control group had usual clinical care. Outcomes—including GP consultations, prescriptions for asthma or wheeze, readmissions, or emergency department visits—were measured up to 12 months.

Both groups (intervention 87 children; control 90 children) had comparable baseline characteristics and did not differ significantly for any outcome measure.

The authors point to the major difference in children's age between their trial and previous trials. They suggest that repeat consultations and readmissions in their study may have been for episodic viral asthma, common in young children and present in 56% of the recruits. Current advice may therefore be unsuitable for preschool children.