Despite conflicting evidence, the British Thoracic Society recommends 3 days of oral prednisolone for pre-school children with moderate to severe wheeze. A study in three New Zealand hospitals randomised children aged 24–59 months with acute wheeze associated with respiratory illness to 2 mg/kg (maximum 40 mg) of oral prednisolone (n = 238) or placebo (n = 239) for 3 days.1 There was no difference between groups in the primary outcome measure, the Pre-school Respiratory Assessment Measure (PRAM) score at 24 h (P = 0.09). The PRAM score was lower in the prednisolone group at 4 h (P = 0.01) and 24 h (P = 0.01), although symptoms had resolved for most children in both groups by this time. The rate of hospital admission was 23.5% in the prednisolone group compared with 31.4% in the placebo group (odds ratio = 0.67, 95% confidence interval 0.45–1.01), and the prednisolone group were less likely to need intravenous medication (1.3% vs. 5.4%, P = 0.03). In summary, a minority of children with acute pre-school wheeze benefit from prednisolone.