An Overview of the Effectiveness of Corticoids in Croup: A Systematic Literature Review

Abstract

Croup, also known as laryngotracheobronchitis, frequently leads to blockages in the upper respiratory tract in young children, presenting symptoms, such as a raspy voice, a distinctive cough, and noisy breathing during inhalation. Despite being a condition that often resolves on its own, it puts considerable strain on healthcare resources due to regular doctor visits, emergency room usage, and occasional hospital stays. Research focused on larger populations suggests that only a small percentage of children with croup end up requiring hospital admission for their condition. In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we executed a meticulous systematic review by scouring databases, such as PubMed, Google Scholar, and the Cochrane Library. A total of 10 articles met our inclusion criteria and were selected for in-depth analysis. These scholarly works provided substantive insights into the pharmacological agents deployed in the treatment of croup. From a clinical standpoint, the management of croup is highly contingent on the patient's hemodynamic status. Our review discerned a pronounced preference for corticosteroids as the primary therapeutic intervention over other alternatives, which are largely relegated to second-line or emergency applications. Interestingly, we found negligible differences among the various corticosteroid treatment options in terms of statistical significance, underscoring their broad utility in ameliorating the condition. In addition to corticosteroids, our review also explored other therapeutic options, such as heliox, nebulized adrenaline, and even natural interventions, such as exposure to outdoor cold air. The efficacy of these treatments demonstrated variable results, reinforcing the notion that while they may be useful in specific circumstances, they are not universally applicable or as robustly effective as corticosteroids. Given the preponderance of evidence favoring corticosteroids, further research is warranted to solidify their status as the first-line treatment in different medical settings, be it inpatient hospitals, outpatient clinics, or even for home-based care. Such studies will not only add a layer of confidence in current medical practice but could also potentially optimize treatment protocols, contributing to improved patient outcomes. Therefore, advancing our understanding of the effectiveness of corticosteroids as the cornerstone of croup management remains an area of paramount scientific and clinical importance.

Use of corticosteroids for croup in children

“…Although croup is a self-limiting illness, the significant benefit of corticosteroids is well documented 11. A recent Cochrane review of 45 randomised controlled trials conducted between 1964 and 2021, involving 5888 children with croup, was published in 2023 7.…”

“…The above vignette outlines a presentation of moderate-to-severe croup, with the parents’ expectations reflecting the outcomes that we aspire to achieve as clinicians. However, current practice often differs between hospitals, with different formulations and strengths of corticosteroids being used 7 11 12. This Medicines Update aims to explore recent evidence around the optimal utility of corticosteroids for croup and demonstrate an evidence-based approach to achieving the best clinical outcomes for the child and their family.…”