Oral and inhaled steroids in croup: A randomized, placebo‐controlled trial

Abstract

It was the objective of this study to compare the efficacy of oral dexamethasone and inhaled budesonide in children hospitalized with croup, using a three-way, double blind, randomized, placebo-controlled clinical trial design. The trial was carried out in the Emergency Department Observation Ward of a tertiary pediatric hospital. The subjects for the study were 80 children (age range 5 to 158 months) who were hospitalized with croup. Children received either 2 mg of nebulised budesonide, dexamethasone syrup (0.6 mg/kg) or a placebo. Median duration of hospitalization was shorter for children treated with dexamethasone (12 hr) and budesonide (13 hr) compared to placebo (20 hr) (P < 0.03). There was no significant difference in hospitalization time between children treated with dexamethasone and budesonide. Median time to a croup score of < or = 1 was shorter for children treated with dexamethasone (2 hr) or budesonide (3 hr) compared to those who received placebo (8 hr) (P < 0.01). Croup scores for both steroid groups were significantly lower than the placebo group by 1 hr and remained so subsequently. The croup scores did not differ significantly in the 2 steroid treated groups. Six of the 30 children (20%) in the placebo group required adrenaline after the first hour compared to none of the 50 children in the steroid treated groups (P < 0.02). We conclude that oral dexamethasone and inhaled budesonide are both effective in reducing symptoms and duration of hospitalization in children with croup.

Interobserver variability of croup scoring in clinical practice

“…Of the various items that have been proposed to be included in a composite croup score, the most reliable, based on our study in a practice setting and two research studies (15,30), are stridor and retractions. Educational sessions for physical therapists have been shown to improve inter-rater reliability of lung auscultation (31).…”

“…Twelve items (level of consciousness or mental status, inspiratory breath sounds, air entry, stridor, cough, cyanosis or colour, anxiety or air hunger, retractions and/or flaring, respiratory rate and heart rate, oxygen saturation and respiratory distress) were identified from 10 croup scoring instruments (6,(8)(9)(10)(11)(12)(13)(14)(15)(16) (Table 1). Five other scoring instruments modified single items in a previously published score (17)(18)(19).…”

Clinical management of upper airway obstruction: epiglottitis and laryngotracheobronchitis

“…O potencial efeito benéfico ocorreria pela diminuição do edema da mucosa laríngea devido a sua ação antiinflamatória. A melhora clínica esperada não ocorreria antes de 4 a 6 horas de tratamento, embore alguma evidências clínicas apontassem para um alívio da sintomatologia de maneira mais precoce, até duas horas após sua administração 23 .…”

“…Em 1995, Geelhoed e colaboradores 23 desenvolveram um estudo para comparar a ação do uso de esteróide por via oral e por via inalatória no alívio de sintomas obstrutivos de via aérea superior em pacientes portadores de crupe. Concluíram que não existem diferenças significativas quanto à diminuição da severidade dos sintomas nem quanto ao tempo de hospitalização, considerando a ação entre as duas drogas.…”

Medicines used in respiratory diseases only seen in children

“…The oral or i.m. routes have been shown to be either equivalent or superior to inhalation [203][204][205][206]. The addition of inhaled budesonide to oral dexamethasone was shown to offer no advantage in hospitalised children [207].…”