Lederle 1987.

Methods	Design: randomised, double‐blind trial Duration: corticosteroid treatment continued for 7 weeks post discharge; follow‐up continued until 12 weeks after initial admission Setting: treatment initiated while inpatient and completed at home
Participants	Population: 43 adults with an acute exacerbation of asthma were randomised to a long taper course (n = 22) or a short taper course (n = 21) of prednisolone Age: 30‐78 years; mean age in long taper group 62.6 years and in short taper group 63 years Inclusion criteria: men admitted to medicine services with exacerbation of asthma requiring systemic steroids; exacerbation defined as worsening dyspnoea due to airways obstruction with no other cause identified, and evidence of a reversible component to obstruction Exclusion criteria: already receiving oral corticosteroids; evidence of pneumonia, pulmonary oedema or cardiomegaly on chest x‐ray; other significant lung disease such as bronchiectasis, fibrosis, cancer; renal failure, hepatic failure and inability to comply with study protocol Percentage withdrawn: withdrawal 0% in both treatment arms Allowed medication: beta‐agonists and theophylline allowed at treating physician's discretion. Inhaled beclomethasone given throughout study period Disallowed medication: antibiotics not allowed once tapering period had begun
Interventions	Prednisolone long taper group: 45 mg prednisolone once daily reducing by 5 mg weekly to 0 mg daily over 7 weeks (total dose 1575 mg prednisolone equivalent) Prednisolone short taper group: 45 mg prednisolone once daily reducing by 5 mg daily to 0 mg daily over 7 days (total dose 225 mg prednisolone equivalent)
Outcomes	Failure of tapering regimen (defined as re‐exacerbation of asthma requiring further corticosteroid administration during 12‐week follow‐up period); symptom diary with 10‐point VAS to evaluate breathing each day from 'best' to 'worst'; physical examination, spirometry, symptoms, adverse events and compliance assessed at 4, 8 and 12 weeks post admission
Notes	Type of publication: peer‐reviewed Funding: placebo tablets provided by Rowell Laboratories Inc., Baudette, Minn Other: mean age in both groups over 60, all but 5 included participants with > 10 pack‐year smoking history, mean of 49 years of age in long‐taper group and 56 in short‐taper group. Baseline spirometry results also suggest that many participants may have had a diagnosis of COPD (mean FEV1/FVC in both groups < 0.7). Study authors acknowledge that many participants may have had COPD with a reversible component
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	"Patients were randomly assigned.."; no further details
Allocation concealment (selection bias)	Unclear risk	No details
Blinding of participants and personnel (performance bias) All outcomes	Low risk	All participants received identical calender blister packs that contained the tapering regimen
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Primary outcome of failure of tapering regimen (i.e. re‐exacerbation requiring additional oral steroids) decision made by physician blinded to participant allocation, as was decision to admit.
Incomplete outcome data (attrition bias) All outcomes	Low risk	All 43 enrolled and randomised participants followed up to 12 weeks as planned (2 withdrew before starting taper; results not included)
Selective reporting (reporting bias)	High risk	Not all outcomes reported in a way allowing for meta‐analysis. FEV1 outcome reported as percentage of baseline value without variance. Diary measures narratively reported in text with minimal supporting data
Other bias	Low risk	None noted