Nebulized Budesonide and Oral Dexamethasone for Treatment of Croup: A Randomized Controlled Trial

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.

Pharmacotherapy of Acute Stenosing Laryngotracheitis. What Drugs Are Data-Based?

“…There are several versions of it; the original scale takes into account the following symptoms: stridor (0-2 points), chest wall retraction (0-3), air entry (0-2 points), cyanosis when breathing room air (0 -5 points), consciousness (0-5 points) [10].Positive results of the inhaled corticosteroid are also described in patients with mild / moderately symptomatic ASLT. It was shown that appointment of a suspension of budesonide for patients with Westley index from 2 to 7 points led to a rapid (within the first 4 hours) and clinically significant improvement (from 4 to 1 point) [11]. Satisfactory response to therapy was observed after 4 hours in 70% of patients treated with inhaled corticosteroid, and only in 37% of the placebo group patients [11].…”

“…It was shown that appointment of a suspension of budesonide for patients with Westley index from 2 to 7 points led to a rapid (within the first 4 hours) and clinically significant improvement (from 4 to 1 point) [11]. Satisfactory response to therapy was observed after 4 hours in 70% of patients treated with inhaled corticosteroid, and only in 37% of the placebo group patients [11].…”

Bridging the Gap between Clinical Research and Knowledge Translation in Pediatric Emergency Medicine

“…Through their research, significant contributions have been made to the evidence base for the treatment of croup and bronchiolitis, 2-14 the use of radiology for ankle and knee injuries in children, 15,16 the use of computed tomography in children with minor head injury, [17][18][19] and the implementation of spacers and metered-dose inhalers in the ED. 20 The quality of the research is reflected in substantial funding from major provincial and national funders, as well as publications in high-impact journals such as the New England Journal of Medicine, 2,4 the Journal of the American Medical Association, 5,21 and the British Medical Journal. 7 The research conducted by PERC members has been principally driven by single investigators or centers and funded on a per-project basis from various sources.…”

“…Research of Canada (PERC) members who have conducted a substantial number of randomized controlled trials (RCTs) to evaluate the efficacy of different treatments for croup [1][2][3][4][5] and most importantly to solidly demonstrate the benefit of corticosteroids and the relative efficacy of different corticosteroids in croup of varying severity. 2,4,5 The nature of the RCTs demonstrates the maturity and successes of this research team; earlier studies involved single centers with relatively small samples (e.g., 54 patients 1 and 50 patients 5 ) compared with a more recent trial involving four centers and 720 children.…”

“…2,4,5 The nature of the RCTs demonstrates the maturity and successes of this research team; earlier studies involved single centers with relatively small samples (e.g., 54 patients 1 and 50 patients 5 ) compared with a more recent trial involving four centers and 720 children. 2 The findings regarding the use of corticosteroids for croup from RCTs have been confirmed and strengthened by a meta-analysis conducted by PERC members.…”