Nebulized Budesonide and Oral Dexamethasone for Treatment of Croup

Abstract

Context.-The effectiveness of glucocorticoids for patients with croup is well established but it remains uncertain which glucocorticoid regimen is most effective. Objective.-To determine the effectiveness of 3 glucocorticoid regimens in patients with croup. Design.-Randomized controlled trial with parallel design. Setting.-Emergency departments of 2 Canadian pediatric tertiary care hospitals. Participants.-Children with a clinical syndrome consistent with croup, aged 3 months to 5 years, with a croup score of 2 or greater following at least 15 minutes of mist therapy. Interventions.-Oral dexamethasone, 0.6 mg/kg, and nebulized placebo; oral placebo and nebulized budesonide, 2 mg; or oral dexamethasone, 0.6 mg/kg, and nebulized budesonide, 2 mg. Main Outcome Measures.-Westley croup score (primary outcome), hospital admission rates, time spent in the emergency department, return visits to the emergency department, or ongoing symptoms at 1 week. Results.-The mean change in the croup score from baseline to the final study assessment was −2.3 (95% confidence interval [CI], −2.6 to −2.0) in the budesonide group (n = 65), −2.4 (95% CI, −2.6 to −2.2) in the dexamethasone group (n = 69), and −2.4 (95% CI, −2.7 to −2.1) in the budesonide and dexamethasone group (n = 64, P = .70). Conclusions.-Based on the similar outcomes in the 3 groups, oral dexamethasone is the preferred intervention because of its ease of administration, lower cost, and more widespread availability.

A comparison of nebulized budesonide, and intramuscular, and oral dexamethasone for treatment of croup

“…However, they found no statistically significant difference between oral dexamethasone and nebulized budesonide compatible with our results. In another study, nebulized budesonide, oral dexamethasone and a combination of these were given to the patients with croup, but no statistically significant difference was found among the groups [16]. It was suggested that oral dexamethasone could be used in day care settings, emergency departments, and office practice.…”

Animal Pneumoviruses: Molecular Genetics and Pathogenesis

“…To this end, glucocorticoids are generally considered to have broad-reaching anti-inflammatory properties and in fact have been the focus of several clinical hRSV trials. Unfortunately, these trials suggest that when used alone in the absence of antivirals, glucocorticoid treatment has only marginal, if any, benefit in the treatment of hRSV-infection and its associated inflammatory response (72,83,84,212,213,231,307,331,334,338,365). A meta-analysis of several these studies demonstrated that systemic glucocorticoids reduced the total length of hospital stay by only 0.43 day per patient, an effect reduced to only 0.29 day per patient when patients with previous episodes of wheezing were excluded from the analysis (137), a statistically significant difference with overall minor clinical impact.…”

Croup: diagnosis and treatment

“…The effectiveness of oral or intramuscular dexamethasone (0.6 mg· kg -1 ) as a treatment for patients with moderate-to-severe croup is well established [2,[14][15][16]. Doses of dexamethasone ranging 0.15-0.6 mg· kg -1 have been shown to be similarly efficacious for treating moderate croup (table 5) [17].…”