pulmicort and Croup

Glucocorticoids are commonly used for croup in children. This is an update of a Cochrane Review published in 1999 and previously updated in 2004 and 2011.. To examine the effects of glucocorticoids for the treatment of croup in children aged 0 to 18 years.. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, Issue 2, 2018), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Ovid MEDLINE (1946 to 3 April 2018), and Embase (Ovid) (1996 to 3 April 2018, week 14), and the trials registers ClinicalTrials.gov (3 April 2018) and the World Health Organization International Clinical Trials Registry Platform (ICTRP, 3 April 2018). We scanned the reference lists of relevant systematic reviews and of the included studies.. We included randomised controlled trials (RCTs) that investigated children aged 0 to 18 years with croup and measured the effects of glucocorticoids, alone or in combination, compared to placebo or another pharmacologic treatment. The studies needed to report at least one of our primary or secondary outcomes: change in croup score; return visits, (re)admissions or both; length of stay; patient improvement; use of additional treatments; and adverse events.. One author extracted data from each study and another verified the extraction. We entered the data into Review Manager 5 for meta-analysis. Two review authors independently assessed risk of bias for each study using the Cochrane 'Risk of bias' tool and the certainty of the body of evidence for the primary outcomes using the GRADE approach.. We added five new RCTs with 330 children. This review now includes 43 RCTs with a total of 4565 children. We assessed most (98%) studies as at high or unclear risk of bias. Compared to placebo, glucocorticoids improved symptoms of croup at two hours (standardised mean difference (SMD) -0.65, 95% confidence interval (CI) -1.13 to -0.18; 7 RCTs; 426 children; moderate-certainty evidence), and the effect lasted for at least 24 hours (SMD -0.86, 95% CI -1.40 to -0.31; 8 RCTs; 351 children; low-certainty evidence). Compared to placebo, glucocorticoids reduced the rate of return visits or (re)admissions or both (risk ratio 0.52, 95% CI 0.36 to 0.75; 10 RCTs; 1679 children; moderate-certainty evidence). Glucocorticoid treatment reduced the length of stay in hospital by about 15 hours (mean difference -14.90, 95% CI -23.58 to -6.22; 8 RCTs; 476 children). Serious adverse events were infrequent. Publication bias was not evident. Uncertainty remains with regard to the optimal type, dose, and mode of administration of glucocorticoids for reducing croup symptoms in children.. Glucocorticoids reduced symptoms of croup at two hours, shortened hospital stays, and reduced the rate of return visits to care. Our conclusions have changed, as the previous version of this review reported that glucocorticoids reduced symptoms of croup within six hours.

Topics: Adolescent; Beclomethasone; Betamethasone; Budesonide; Child; Child, Preschool; Croup; Dexamethasone; Epinephrine; Fluticasone; Glucocorticoids; Humans; Infant; Infant, Newborn; Prednisolone; Randomized Controlled Trials as Topic

Viral croup is a frequent disease in early childhood. Although it is usually self-limited, it may occasionally become life-threatening. Mild croup is characterized by the presence of stridor without intercostal retractions, whereas moderate-to-severe croup is accompanied by increased work of breathing. A single dose of orally administered dexamethasone (0.15-0.6 mg/kg) is the mainstay of treatment with addition of nebulized epinephrine only in cases of moderate-to-severe croup. Nebulized budesonide (2 mg) can be given alternatively to children who do not tolerate oral dexamethasone. Exposure to cold air or administration of cool mist are treatment interventions for viral croup that are not supported by published evidence, but breathing heliox can potentially reduce the work of breathing related to upper airway obstruction. In summary, corticosteroids may decrease the intensity of viral croup symptoms irrespective to their severity on presentation to the emergency department.

Topics: Administration, Inhalation; Administration, Oral; Algorithms; Anti-Inflammatory Agents; Bronchodilator Agents; Budesonide; Child; Child, Preschool; Croup; Dexamethasone; Helium; Humans; Infant; Oxygen; Racepinephrine; Severity of Illness Index

Croup is characterised by the abrupt onset, most commonly at night, of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction. It leads to signs of upper airway obstruction, and must be differentiated from acute epiglottitis, bacterial tracheitis, or an inhaled foreign body. Croup affects about 3% of children per year, usually between the ages of 6 months and 3 years, and 75% of infections are caused by parainfluenza virus. Symptoms usually resolve within 48 hours, but severe upper airway obstruction can, rarely, lead to respiratory failure and arrest.. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in children with mild croup and moderate to severe croup? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).. We found 19 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.. In this systematic review we present information relating to the effectiveness and safety of the following interventions: corticosteroids (dexamethasone, intramuscular and oral), nebulised budesonide, oral prednisolone, heliox, humidification, and nebulised adrenaline (racemate and L-adrenaline [ephinephrine]).

Topics: Adrenal Cortex Hormones; Budesonide; Cough; Croup; Epinephrine; Helium; Humans; Humidity; Oxygen; Prednisolone

Since the initial publication of this systematic review in 1997, several randomized trials examining the benefit of glucocorticoids have been published. The objective of this review is to provide evidence to guide clinicians in their treatment of patients with croup by determining the effectiveness of glucocorticoids and to identify areas requiring future research.. To determine the effect of glucocorticoids for children with croup.. We searched CENTRAL (2010, Issue 3), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to July week 2, 2010) and EMBASE.com (1974 to July 2010). We also contacted authors of identified croup trials published in the last 10 years to inquire about additional published or unpublished trials.. Randomised controlled trials (RCTs) that examine children with croup and objectively measure the effectiveness of glucocorticoids.. Two review authors identified studies for potential relevance based on the review of the title and abstract (when available). Two review authors independently reviewed studies for relevance using a priori inclusion criteria and assessed trial quality. Differences were resolved by consensus. One review author extracted data using a structured form and another review author checked the results for accuracy. We performed standard statistical analyses.. Thirty-eight studies were included (n = 4299). Glucocorticoids were associated with an improved Westley score (maximum 17 points) at six hours with a mean difference of -1.2 (95% confidence interval (CI) -1.6 to -0.8) and at 12 hours -1.9 (95% CI -2.4 to -1.3); at 24 hours this improvement was no longer significant (-1.3, 95% CI -2.7 to 0.2). Fewer return visits and/or (re)admissions occurred in participants treated with glucocorticoids (risk ratio (RR) 0.5; 95% CI 0.3 to 0.7). Length of time spent in accident and emergency or hospital (mean difference 12 hours, five to 19 hours) was significantly decreased for participants treated with glucocorticoids. Use of epinephrine decreased for children treated with a glucocorticoid (risk difference 10%; 95% CI 1 to 20).. Dexamethasone and budesonide are effective in relieving the symptoms of croup as early as six hours after treatment. Fewer return visits and/or (re)admissions are required and the length of time spent in hospital is decreased. Research is required to examine the most beneficial method for disseminating croup practice guidelines and to increase the uptake of evidence.

Topics: Androstadienes; Budesonide; Child; Croup; Dexamethasone; Epinephrine; Fluticasone; Glucocorticoids; Humans; Prednisolone; Randomized Controlled Trials as Topic; Severity of Illness Index; Time Factors

Croup leads to signs of upper airway obstruction, and must be differentiated from acute epiglottitis, bacterial tracheitis, or an inhaled foreign body. Croup affects about 3% of children a year, usually between the ages of 6 months and 3 years, and 75% of infections are caused by Parainfluenza virus. Symptoms usually resolve within 48 hours, but severe infection can, rarely, lead to pneumonia, and to respiratory failure and arrest.. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments in children with: mild croup; moderate to severe croup; and impending respiratory failure because of severe croup? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2008 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).. We found 43 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.. In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, corticosteroids, dexamethasone (intramuscular, oral, single-dose oral, route of administration), heliox, humidification, intermittent positive pressure breathing, L-adrenaline, nebulised adrenaline (epinephrine), nebulised budesonide, nebulised short-acting beta(2) agonists, oral decongestants, oral prednisolone, oxygen, and sedatives.

Topics: Administration, Inhalation; Administration, Oral; Adrenal Cortex Hormones; Budesonide; Croup; Dexamethasone; Epinephrine; Humans; Infant

Topics: Bronchodilator Agents; Budesonide; Child; Child, Preschool; Croup; Dexamethasone; Epinephrine; Humans; Nebulizers and Vaporizers

Since the 1960s, corticosteroids have been used in the treatment of laryngotracheobronchitis, commonly called croup. Initially, their use for croup was controversial and highly debated in the literature. The evidence over the last 2 decades has strongly favored corticosteroid use in croup management. It has now become the standard of care to use corticosteroids in moderate-to-severe croup. Corticosteroid use in these patients has been shown to reduce hospitalizations, length of illness, and subsequent treatments when compared with placebo. By extrapolation, corticosteroids may even play a role in patients with milder croup presenting for medical assessment. The current recommendation is to treat patients with moderate-to-severe croup with oral dexamethasone in a dose of 0.6 mg/kg (maximum 10-12 mg) because of its ease of administration, easy availability, and low cost. Intramuscular dexamethasone is reserved for patients who are vomiting or who are in severe respiratory distress and unable to tolerate oral medication. Nebulized budesonide, used commonly in some geographic locations, has been found to be effective, but is often not used in favor of the oral corticosteroids. Controversy still exists over the use of corticosteroids in mild and potentially self-limiting disease. Some evidence exists for treating these patients; some clinicians use corticosteroids for all patients with croup who seek care regardless of the severity of the illness. Patients with mild disease may be candidates for lower doses of dexamethasone such as 0.15-0.3 mg/kg. Corticosteroid-induced complications in croup are rare. Overall, corticosteroids have gained universal acceptance for the treatment of croup and have been found to be effective, well tolerated, and inexpensive.

Topics: Administration, Inhalation; Administration, Oral; Adrenal Cortex Hormones; Ambulatory Care; Anti-Inflammatory Agents; Budesonide; Child; Croup; Dexamethasone; Dose-Response Relationship, Drug; Humans; Injections, Intramuscular; Severity of Illness Index; Treatment Outcome

Topics: Bronchodilator Agents; Budesonide; Child; Child, Preschool; Croup; Dexamethasone; Epinephrine; Humans; Infant; Nebulizers and Vaporizers

Croup, or laryngotracheobronchitis, is a common childhood illness most often caused by viral infections. It is usually a benign, self-limiting disease, but can result in life-threatening upper airway obstruction. Until recently, it was not uncommon for children with severe croup to be admitted to intensive care for intubation. Management used to be limited to supportive measures, including mist therapy. The use of corticosteroids in patients with croup was controversial for many years but has, in the last decade, transformed the management of this disorder. Although corticosteroids do not alter the history of the viral infection, an adequate dose of oral or parenteral dexamethasone or nebulized budesonide has been shown to have a beneficial effect on the symptoms of croup.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Bronchodilator Agents; Budesonide; Child; Croup; Dexamethasone; Epinephrine; Humans; Nebulizers and Vaporizers

Croup is one of the commonest respiratory complaints among children. There is growing evidence that steroids may be an effective treatment.. To assess the effectiveness of treatment with nebulised steroid for children with croup.. Systematic review of randomised controlled trials comparing administration of nebulised steroid with placebo. Trials were identified from searches of three bibliographic databases, the Cochrane Controlled Trials Register, correspondence with the manufacturers of nebulised steroid, and one round of manual citation searching.. Eight randomised controlled trials were identified including 574 children with mild to severe croup. Overall, the mean age was 25.2 months and 72% of children were male. All trials were hospital-based and of good methodological quality, with adequate concealment of treatment allocation and blind outcome assessment. Children treated with nebulised steroid were significantly more likely to show an improvement in croup score by five hours (combined relative risk = 1.48, 95% confidence interval [CI] = 1.27 to 1.74) and significantly less likely to need hospital admission after attending the emergency department (combined relative risk = 0.56, 95% CI = 0.42 to 0.75) than the placebo group. The funnel plot indicated the presence of publication bias, with smaller studies showing the larger effects, but this could also be owing to less pronounced effects in studies of older children with milder croup.. Nebulised steroids are effective in the treatment of children attending hospital departments with croup. A meta-analysis based on individual patient data could clarify to what extent the effect depends on age and severity of disease. New trials are needed to define the indications for, and effectiveness of, steroid treatment of croup in the community.

Topics: Anti-Inflammatory Agents; Budesonide; Child; Child, Preschool; Croup; Female; Humans; Infant; Male; Nebulizers and Vaporizers; Placebos; Randomized Controlled Trials as Topic; United Kingdom

Budesonide, a topically active corticosteroid, has a broad spectrum of clinically significant local anti-inflammatory effects in patients with inflammatory lung diseases including persistent asthma. In infants and young children with persistent asthma, day- and night-time symptom scores, and the number of days in which beta2-agonist bronchodilators were required, were significantly lower during randomised, double-blind treatment with budesonide inhalation suspension 0.5 to 2 mg/day than placebo in 3 multicentre trials. Significantly fewer children discontinued therapy with budesonide inhalation suspension than with placebo because of worsening asthma symptoms in a study that included children who were receiving inhaled corticosteroids at baseline. Recent evidence indicates that budesonide inhalation suspension is significantly more effective than nebulised sodium cromoglycate in improving control of asthma in young children with persistent asthma. At a dosage of 2 mg/day, budesonide inhalation suspension significantly reduced the number of asthma exacerbations and requirements for systemic corticosteroids in preschool children with severe persistent asthma. In children with acute asthma or wheezing, the preparation was as effective as, or more effective than oral prednisolone in improving symptoms. In children with croup, single 2 or 4mg dosages of budesonide inhalation suspension were significantly more effective than placebo and as effective as oral dexamethasone 0.6 mg/kg or nebulised L-epinephrine (adrenaline) 4mg in alleviating croup symptoms and preventing or reducing the duration of hospitalisation. Early initiation of therapy with budesonide inhalation suspension 1 mg/day appears to reduce the need for mechanical ventilation and decrease overall corticosteroid usage in preterm very low birthweight infants at risk for chronic lung disease. In adults with persistent asthma, budesonide inhalation suspension < or =8 mg/day has been compared with inhaled budesonide 1.6 mg/day and fluticasone propionate 2 mg/day administered by metered dose inhaler. Greater improvements in asthma control occurred in patients during treatment with budesonide inhalation suspension than with budesonide via metered dose inhaler, whereas fluticasone propionate produced greater increases in morning peak expiratory flow rates than nebulised budesonide. Several small studies suggest that the preparation has an oral corticosteroid-sparing effect in adults with persistent asthma

Topics: Administration, Inhalation; Adolescent; Adult; Aged; Asthma; Bronchiolitis; Bronchodilator Agents; Budesonide; Child; Child, Preschool; Clinical Trials as Topic; Croup; Drug Delivery Systems; Female; Humans; Infant; Infant, Newborn; Lung Diseases, Obstructive; Male; Middle Aged

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Anti-Inflammatory Agents; Bronchodilator Agents; Budesonide; Child, Preschool; Croup; Dexamethasone; Epinephrine; Glucocorticoids; Humans; Humidity; Infant

Topics: Administration, Inhalation; Bronchodilator Agents; Budesonide; Child; Child, Preschool; Croup; Epinephrine; Humans; Infant; Pregnenediones; Randomized Controlled Trials as Topic

Now that there is widespread acceptance of glucocorticoids for inpatient treatment of croup, the focus of research has shifted to the effectiveness of glucocorticoids for outpatients with croup. Recent evidence from randomized controlled trials has shown that nebulized budesonide causes an acute improvement in croup symptoms, shortens stay in the emergency department, and significantly reduces admission rate. Intramuscular or oral dexamethasone also result in acute clinical improvement in patients with croup, and oral dexamethasone reduces the length of stay in an emergency department observation unit. There is accumulating evidence that patients receiving epinephrine do not necessarily require hospitalization but when treated simultaneously with dexamethasone may be safely discharged to home after a 3-hour observation period. Future trials in outpatients with croup need to determine the optimal dosing of oral dexamethasone, the utility of epinephrine therapy alone or in combination with glucocorticoids, and the optimal glucocorticoid regimen (budesonide, dexamethasone, or budesonide and dexamethasone).

Topics: Ambulatory Care; Anti-Inflammatory Agents; Budesonide; Child; Clinical Trials as Topic; Croup; Dexamethasone; Epinephrine; Glucocorticoids; Humans; Pregnenediones

Eosinophilic cationic protein (ECP) and immunoglobulin E (IgE) are important mediators of allergic inflammation and they are commonly used in the diagnosis and follow-up of allergic diseases. But serum levels of these molecules can also be elevated by some other diseases including viral infections. Acute laryngotracheobronchitis (ALTB) is an important viral infection of upper airway and serum levels of ECP and IgE may increase in patients with ALTB.. In the present study serum ECP and IgE levels were measured before treatment and on the third day and third week after treatment in 27 patients with ALTB aged 10 months to 5 years and were compared with a age matched healthy controls. All patients were treated with nebulized budesonide.. We found that pre-treatment ECP levels were significantly higher than post-treatment third days and third weeks (28.3+/-2.3 ng/ml versus 20.2+/-3.2 ng/ml and 11.4+/-1.1 ng/ml, respectively). Similarly, the mean pre-treatment serum IgE values were significantly higher than post-treatment values (131.6+/-17.5 IU/ml versus 83.6+/-12.4 IU/ml and 68.2+/-6.7 IU/ml). A positive correlation was found between serum ECP and IgE values for pre-treatment and post-treatment third week values (r=062, p=0.01 and r=0.64, p=0.01, respectively). The pre-treatment serum ECP and IgE levels were significantly higher than those of controls (10.8+/-1.5 ng/ml and 43.8+/-6.6 IU/ml, respectively p<0.05).. In this study it was shown that, serum ECP and IgE levels increase in the acute phase of infection and return to normal after treatment in patients with ALTB such as in allergic patients. This effect of ALTB on serum ECP and total IgE levels should be kept in mind and these parameters should not be used in the diagnosis and follow-up of allergic diseases in children who had had ALTB in recent weeks.

Topics: Bronchodilator Agents; Budesonide; Child, Preschool; Croup; Eosinophil Cationic Protein; Female; Humans; Immunoglobulin E; Infant; Male; Nebulizers and Vaporizers; Time Factors; Treatment Outcome

To evaluate the effect of adding inhaled budesonide (2 mg) to oral dexamethasone 0.15 mg/kg in children hospitalized with croup.. Observation ward of a Tertiary Paediatric Hospital Emergency Department.. Seventy-two children (age range 3 to 126 months) hospitalized with croup.. Children randomized to receive either 2 mg of nebulized budesonide or placebo, with all children receiving a single oral dose of 0.15 mg/kg dexamethasone.. Primary outcome was duration of hospital stay. Other measures included croup scores from 0 to 12 hours, use of nebulized epinephrine, duration of croup symptoms, duration of viral symptoms, and return to medical care for croup or for any other reason following discharge from hospital.. Baseline characteristics for the 2 groups were similar. There was no difference in time to discharge for the 2 groups or for other outcome measures with a risk ratio of 1.3 (95% confidence intervals of 0.82 and 2.1).. The addition of inhaled budesonide (2 mg) to oral dexamethasone (0.15 mg/kg) offers no advantage in the treatment of children hospitalized with croup.

Topics: Administration, Inhalation; Administration, Oral; Bronchodilator Agents; Budesonide; Child; Child, Preschool; Croup; Dexamethasone; Drug Therapy, Combination; Glucocorticoids; Humans; Infant; Length of Stay; Patient Readmission; Treatment Outcome

Croup or acute laryngotracheobronchitis is the most common cause of the upper airway obstruction. Cool mist, nebulized racemic epinephrine and steroids are commonly used for therapy. Although steroid treatment can be applied orally, in nebulized form, or parenterally, no study has compared these three regimens yet. In this study, the efficacy of nebulized budesonide, and oral and intramuscular dexamethasone are compared for treatment of croup.. Sixty children aged 6-36 months were randomly allocated into four groups. The first three study groups (15 children in each) took nebulized budesonide, oral dexamethasone and intramuscular dexamethasone, respectively, in addition to salbutamol and other supportive measures and these were compared with the placebo group. All patients were evaluated with "Westley Croup Score" on admission to pediatric emergency department (0h) and at 24, 48 and 72h.. At the end of the study, the croup scores of all steroid treatment groups were significantly lower than the placebo group, but there was no statistical difference among them.. Nebulized budesonide, oral and parenteral dexamethasone have the same effectiveness for treatment of croup and the choice depends on conditions of the patient and the physician.

Topics: Administration, Intranasal; Administration, Oral; Aerosols; Anti-Inflammatory Agents; Budesonide; Child, Preschool; Croup; Dexamethasone; Female; Humans; Infant; Injections, Intramuscular; Male; Random Allocation; Treatment Outcome

To investigate the efficacy and tolerance of 12-hourly dosing with 2 mg 4 mL-1 of inhaled budesonide versus placebo in patients admitted to hospital with moderate/severe croup.. Eighty-two children hospitalised with croup received either 2 mg 4 mL-1 of budesonide or placebo 12 hourly (maximum four doses) via Ventstream nebuliser in a randomised, double-blind manner. Croup scores were performed at 0, 2, 6, 12, 24, 36 and 48 h from initial nebulisation whilst the patient remained hospitalised. Follow-up assessments were made 1 and 3 days after discharge.. Improvement was observed in the budesonide group over the 12-h dosing interval when compared to placebo (P = 0.04). Time to attain a significant clinical improvement was superior in the budesonide group (P = 0.01). Three days after discharge seven of 32 placebo-treated patients and one of 34 budesonide-treated patients had sought further medical follow-up (P = 0.02).. Twelve-hourly dosing with inhaled budesonide significantly improved symptoms of croup as well as decreased relapse rates when compared with placebo.

Topics: Administration, Inhalation; Anti-Inflammatory Agents; Budesonide; Chi-Square Distribution; Child; Child, Preschool; Croup; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Infant; Male; Reference Values; Treatment Outcome

We randomised 59 children hospitalized for croup to treatment with either inhaled budesonide or injected dexamethasone. Group A were treated with two inhalations of 1000 micrograms budesonide and group B received dexamethasone 0.6 mg/kg intramuscularly. We used a modified Westley-score, based on chest-wall retractions, barking cough, respiratory frequency and stridor. The children was aged three months to six years (mean 20 months). Three hours after the first treatment there was significant improvement in score amongst all children (p < 0.001), but no difference between the two groups (p < 0.20). Six and 12 hours after the first treatment there were significantly better clinical scores in group B (p = 0.001, p = 0.0004). Based on this study we recommend dexamethasone 0.6 mg/kg intramuscularly for children to be treated for croup.

Topics: Administration, Inhalation; Anti-Inflammatory Agents, Non-Steroidal; Budesonide; Child; Child, Preschool; Croup; Dexamethasone; Humans; Infant; Injections, Intramuscular

The effectiveness of glucocorticoids for patients with croup is well established but it remains uncertain which glucocorticoid regimen is most effective.. To determine the effectiveness of 3 glucocorticoid regimens in patients with croup.. Randomized controlled trial with parallel design.. Emergency departments of 2 Canadian pediatric tertiary care hospitals.. 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.. 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.. 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.. 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).. 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.

Topics: Administration, Intranasal; Administration, Oral; Budesonide; Child, Preschool; Croup; Dexamethasone; Emergency Service, Hospital; Female; Glucocorticoids; Humans; Infant; Male; Nebulizers and Vaporizers; Treatment Outcome

In children with croup, treatment with nebulized budesonide decreases symptoms, but it is uncertain how budesonide compares with dexamethasone, the conventional therapy for croup, and whether either reduces the rate of hospitalization.. We performed a double-blind, randomized trial involving 144 children with moderately severe croup. The children were treated with racepinephrine and a single dose of 4 mg of nebulized budesonide (48 children), 0.6 mg of intramuscular dexamethasone per kilogram of body weight (47 children), or placebo (49 children). The children were assessed before treatment and then hourly for five hours after treatment. Physicians who were unaware of the treatment assignments determined the children's need for further treatment and hospitalization.. The characteristics of the groups were similar at base line, including the types of viruses identified, the types of croup, and the clinical severity of the illness. The overall rates of hospitalization were 71 percent in the placebo group (35 of 49 children), 38 percent in the budesonide group (18 of 48 children), and 23 percent in the dexamethasone group (11 of 47 children) (unadjusted P=0.001 for the comparison of budesonide with placebo, P<0.001 for the comparison of dexamethasone with placebo, and P=0.18 for the comparison of budesonide with dexamethasone). Children treated with budesonide or dexamethasone had a greater improvement in croup scores than those given placebo (P=0.03 and P<0.001, respectively), and those treated with dexamethasone had a greater improvement than those treated with budesonide (P=0.003).. In children with moderately severe croup, treatment with intramuscular dexamethasone or nebulized budesonide resulted in more rapid clinical improvement than did the administration of placebo, with dexamethasone offering the greatest improvement. Treatment with either glucocorticoid resulted in fewer hospitalizations.

Topics: Administration, Inhalation; Analysis of Variance; Bronchodilator Agents; Budesonide; Child, Preschool; Croup; Dexamethasone; Double-Blind Method; Emergency Service, Hospital; Epinephrine; Female; Glucocorticoids; Hospitalization; Humans; Infant; Injections, Intramuscular; Logistic Models; Male; Nasopharynx; Nebulizers and Vaporizers; Racepinephrine

To determine whether nebulised budesonide improves the symptoms or shortens the duration of stay of children admitted to hospital with a clinical diagnosis of croup.. A prospective, randomised, double blind placebo controlled trial. Patients received either nebulised budesonide or placebo every 12 hours. The main outcome measures were duration of inpatient stay and croup scores at 30 minutes, one, two, four, 12, and 24 hours.. 87 patients (89 admissions) aged 7-116 months entered the trial. Nebulised budesonide was associated with a significant improvement in symptoms at 12 hours (95% confidence interval (CI) 1 to 3) and 24 hours (95% CI 0 to 3). Patients with an initial croup score above 3 demonstrated a significant improvement in symptoms at two hours (95% CI 1 to 3). Nebulised budesonide was also associated with a 33% reduction in the length of stay (95% CI 2% to 63%) when the confounding variables of age, initial croup score, and coryzal symptoms were taken into consideration.. Nebulised budesonide is an effective treatment for children admitted to hospital with a clinical diagnosis of croup.

Topics: Administration, Inhalation; Administration, Topical; Anti-Inflammatory Agents; Budesonide; Child; Child, Preschool; Croup; Double-Blind Method; Female; Glucocorticoids; Humans; Infant; Length of Stay; Male; Nebulizers and Vaporizers; Pregnenediones; Prospective Studies

Nebulized budesonide and nebulized adrenaline have been shown to be effective in the treatment of moderately severe croup. However, there has been no direct comparison of these therapies. We undertook a multicenter, randomized, double-blind, parallel group study in 66 hospitalized children with viral or spasmodic croup.. Children 0.5 to 6 years of age were assessed using a validated croup symptom score (stridor, 0 through 4; cough, 0 through 3; retractions, 0 through 3; dyspnea, 0 through 3; and color, 0 through 4) at 0.5, 1, 1.5, 2, 12, and 24 hours after nebulization. Patients received either budesonide (2 mg/4 mL) or L-adrenaline (4 mg/4 mL) via nebulization. The primary outcome measure was change in the total croup symptom score.. Thirty-five children received budesonide and 31 received adrenaline. There was no significant difference in baseline features, including croup score (mean [95% confidence interval]: budesonide, 7.1 [6.7-7.5]; adrenaline, 7.7 [7.3-8.1]). All patients had significant improvement from baseline, and there was not significant difference between the two treatments, as measured by change in croup scores, change in oxygen saturation, duration of hospitalization, number of subsequent treatments with systemic steroids or adrenaline, and adverse events. No child required intubation.. This study does not show any difference in efficacy and safety between nebulized budesonide and nebulized adrenaline in the treatment of acute upper airway obstruction in patients with moderately severe croup.

Topics: Administration, Topical; Adrenergic Agonists; Aerosols; Airway Obstruction; Anti-Inflammatory Agents; Bronchial Spasm; Bronchodilator Agents; Budesonide; Child; Child, Preschool; Croup; Double-Blind Method; Epinephrine; Glucocorticoids; Hospitalization; Humans; Infant; Intubation, Intratracheal; Length of Stay; Nebulizers and Vaporizers; Oxygen; Pregnenediones; Treatment Outcome

To determine the added clinical benefit of nebulized budesonide in children with mild to moderate croup treated with 0.6 mg/kg oral dexamethasone.. Randomized, double-blind, placebo-controlled trial.. Emergency department of a tertiary-care pediatric hospital with 47,000 visits per year.. Children 3 months to 5 years of age with a syndrome consisting of hoarseness, inspiratory stridor, and barking cough and a croup score of 3 or greater after at least 15 minutes of mist therapy. Patients were excluded from the study if they had diagnoses of epiglottitis, chronic upper or lower airway disease (not including asthma), or severe croup or had received corticosteroids within the preceding 2 weeks.. All patients received 0.6 mg/kg oral dexamethasone and were randomly assigned to receive 4 mL (2 mg) of budesonide solution (n=25) or 4 mL of 0.9% saline solution (n=25) by updraft nebulizer with a continuous flow of oxygen at 5 to 6 L/min.. The primary outcome measure was the proportion of patients in each group who had clinically important changes (two points) in the croup score during the 4 hours after treatment.. Eighty-four percent (n=21) of the patients who received budesonide had clinically important responses, compared with 56% (n=14) in the placebo group. The number of patients who would need to be treated with nebulized budesonide for one patient to have a clinically important response is four patients.. Despite receiving simultaneous oral dexamethasone, pediatric outpatients with mild to moderate croup have added, clinically important improvement in respiratory symptoms after treatment with budesonide.

Topics: Administration, Oral; Administration, Topical; Ambulatory Care; Anti-Inflammatory Agents; Bronchodilator Agents; Budesonide; Child, Preschool; Consciousness; Cough; Croup; Cyanosis; Dexamethasone; Double-Blind Method; Drug Therapy, Combination; Female; Follow-Up Studies; Glucocorticoids; Heart Rate; Hoarseness; Humans; Infant; Male; Nebulizers and Vaporizers; Oxygen Inhalation Therapy; Pregnenediones; Pulmonary Ventilation; Respiration; Respiratory Sounds; Treatment Outcome

Topics: Aerosols; Bronchodilator Agents; Budesonide; Child, Preschool; Croup; Dexamethasone; Double-Blind Method; Glucocorticoids; Humans; Infant; Pregnenediones

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.

Topics: Administration, Inhalation; Administration, Oral; Bronchodilator Agents; Budesonide; Child; Child, Preschool; Croup; Dexamethasone; Double-Blind Method; Female; Glucocorticoids; Humans; Infant; Length of Stay; Male; Pregnenediones; Time Factors; Treatment Outcome

The authors examined 85 children who had serious recurrent pseudogroup syndrome, and re-examined them 1-3 years later. 1/3 of the patients was also allergic, mostly to mites and grasspollens. The patients got either regular, daily two inhalation, or their parents were taught to inspire the drug in the case of stenotic cough of hoarseness. Half of the patients did not answer to our letter. The parents of 43 patients answered and described their observations according to the inquiry letter. 2/3 of treated children either amolioreted definitely of became symptom free. 12 patients had 30 laryngeal attacks before the budesonide treatment whereas only 3 attacks, needing hospitalisation, occurred after the budesonide treatment. 6 patients experienced definite amelioration and two children's state worsened. Budesonide therapy seemed to be useful in the prevention and therapy of recurrent laryngitic children. Further experiences using turbo-inhaler and placebo would be important for more definite statement. Nevertheless inhalative budesonide is the first drug promising fast remission of laryngeal edema.

Topics: Bronchodilator Agents; Budesonide; Child; Cough; Croup; Diagnosis, Differential; Female; Follow-Up Studies; Humans; Laryngitis; Male; Pregnenediones; Recurrence; Respiratory Therapy

The aim of this prospective, randomised, double blind study was to evaluate whether inhaled nebulized corticosteroid is effective in the treatment of croup. Thirty-seven children (aged 0.4-4.9 years) admitted to hospital with moderate to severe croup were allocated to treatment with either 2 mg nebulized budesonide (20) or saline (17). Disease severity was assessed by a clinical croup score based on stridor, cough, retractions, dyspnoea and cyanosis, and the overall clinical assessment was scored on a visual log scale (0-100). Two hours after treatment there was a significant improvement in croup score in the group treated with budesonide (8 to 4.5), but not in the group treated with saline (8 to 8). Furthermore, the overall clinical assessment score decreased significantly (50 to 25) in the group treated with budesonide, whereas it remained constant in the placebo group (60 to 62). The results indicate that nebulised budesonide can be used as a safe and effective alternative treatment in children with moderate to severe croup.

Topics: Administration, Inhalation; Aerosols; Bronchodilator Agents; Budesonide; Child, Preschool; Croup; Double-Blind Method; Female; Humans; Infant; Male; Placebos; Pregnenediones; Prospective Studies

Although recent evidence has strongly supported the use of glucocorticoid therapy in children hospitalized with croup, the benefit of this therapy in children with less severe croup has not been documented. This randomized, double-blind trial compared a nebulized glucocorticoid, budesonide, with placebo in outpatients with mild-to-moderate croup.. Children three months to five years of age were eligible for the study if their croup scores fell in the mild-to-moderate range (scores of 2 to 7 out of a possible 17). The patients were randomly assigned to receive either 2 mg (4 ml) of nebulized budesonide (27 children) or 4 ml of nebulized normal saline (27 children); they were then assessed hourly for up to four hours by investigators who were unaware of the assigned treatments.. The median croup score at entry into the study was 4 in both groups. At the final study assessment, the median score was significantly lower in the budesonide group than in the placebo group (1 vs. 3, P = 0.005). The patients in the budesonide group were discharged from the emergency department significantly earlier than those in the placebo group (P = 0.002). One week after enrollment, 21 patients assigned to placebo had received dexamethasone, as compared with 15 patients assigned to budesonide (P = 0.10), and 7 patients assigned to placebo had been admitted to the hospital, as compared with 1 patient assigned to budesonide (P = 0.05).. We conclude that nebulized budesonide leads to a prompt and important clinical improvement in children with mild-to-moderate croup who come to the emergency department.

Topics: Acute Disease; Aerosols; Budesonide; Child, Preschool; Croup; Female; Follow-Up Studies; Glucocorticoids; Humans; Infant; Male; Nebulizers and Vaporizers; Pregnenediones; Treatment Outcome

The aim of this prospective, randomised, double blind study was to evaluate whether nebulised local steroid treatment is effective in the treatment of croup. Thirty six infants and children (0.4-4.9 years of age) admitted to hospital with moderate to severe croup were allocated to receive either 2 mg nebulised budesonide (20 children) or saline (16 children). Disease severity was assessed by a clinical total croup score based on stridor, cough, retractions, dyspnoea, and cyanosis. In addition the overall clinical impression was evaluated (0-100). Two hours after treatment there was a significant improvement in the total croup score in the group treated with budesonide (8 to 4.5), but not in the group treated with saline (8 to 8). Furthermore, the overall clinical impression assessment score decreased significantly (50 to 25) in the group treated with budesonide, whereas it remained constant in the placebo group (60 to 62). The total croup score and overall clinical severity were significantly better in the group treated with budesonide than in the placebo group. No side effects were observed. The results indicate that nebulised budesonide can be used as a safe and effective alternative treatment in children and infants with moderate to severe croup.

Topics: Bronchodilator Agents; Budesonide; Child, Preschool; Croup; Double-Blind Method; Humans; Infant; Nebulizers and Vaporizers; Pregnenediones; Prospective Studies

Topics: Budesonide; Child, Preschool; Croup; Dexamethasone; Diagnosis, Differential; Epinephrine; Glucocorticoids; Humans; Infant; Oxygen; Practice Guidelines as Topic; Respiratory Sounds; Severity of Illness Index

We report the case of a 20-month old boy with markedly elevated serum alkaline phosphatase (ALP) levels, documented during an episode of acute laryngotracheobronchitis. Biochemical investigations and imaging studies revealed no evidence of bone or liver disease. Transient hyperphosphatasemia (TH) was confirmed when serum ALP levels normalized within 2 months. Several theories were suggested for TH pathophysiology, viral infections among them; the exact causes, however, remain unclear. It is important to recognize TH and avoid misdiagnosis and unnecessary investigations.

Topics: Alkaline Phosphatase; Budesonide; Croup; Glucocorticoids; Humans; Infant; Isoenzymes; Male; Methylprednisolone; Nebulizers and Vaporizers; Phosphorus Metabolism Disorders; Treatment Outcome

Topics: Administration, Inhalation; Administration, Oral; Budesonide; Child; Croup; Dexamethasone; Glucocorticoids; Humans

Topics: Administration, Oral; Budesonide; Croup; Dexamethasone; Glucocorticoids; Humans; Meta-Analysis as Topic

Topics: Budesonide; Child, Preschool; Croup; Emergency Medical Services; Epinephrine; Evidence-Based Medicine; Female; Humans; Nebulizers and Vaporizers

Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Budesonide; Child; Child, Preschool; Croup; Dexamethasone; Hospitalization; Humans; Infant; Meta-Analysis as Topic; Reproducibility of Results; Treatment Outcome

Topics: Administration, Inhalation; Bronchodilator Agents; Budesonide; Child; Child, Preschool; Croup; Dexamethasone; Emergency Treatment; Epinephrine; Glucocorticoids; Humans; Infant

Topics: Budesonide; Child, Preschool; Croup; Dexamethasone; Glucocorticoids; Humans; Infant

The diagnoses, transfer, management and outcome of patients with upper airway obstruction (UAO) admitted from district general hospitals (DGH) to a regional paediatric intensive care unit were retrospectively reviewed over a 3.5-year period. Sixty-seven patient episodes were analysed. Fifty-two cases (78%) underwent tracheal intubation prior to transport with a low morbidity for both procedures. The most common diagnosis was viral croup (n = 34, 51%) with a median duration of intubation of 5 days, with subglottic stenosis being the next most common category (n = 10, 15%), median duration of intubation 7 days. Inhaled budesonide was used prior to intubation in 12 (35%) of those with croup, and inhaled bronchodilators in 28%, possibly reflecting diagnostic uncertainty. Patients with croup treated with budesonide were significantly less likely to require intubation (P = 0.04). The re-intubation rate for patients with viral croup was uncomfortably high at 16% (4/25) despite the routine use of prednisolone throughout the intubation period. Successful extubation of patients with viral croup could not be predicted by age (P = 0.31), length of intubation (P = 0.94), endotracheal tube size, (P = 0.60) abnormalities on the chest X-ray (P = 1.0), or presence of secondary bacterial infection (P = 0.23).. Although viral croup remains the most common diagnostic category presenting at the DGH level with severe UAO, a wide range of other diagnoses is seen. Despite clear evidence of benefit, steroid administration to children presenting at the DGH with viral croup has not become routine practice. Once intubated, no reliable predictors of successful extubation were found amongst this patient group.

Topics: Airway Obstruction; Bronchodilator Agents; Budesonide; Child; Child, Preschool; Critical Care; Croup; Hospitals, District; Hospitals, General; Humans; Infant; Infant, Newborn; Intensive Care Units, Pediatric; Intubation, Intratracheal; London; Patient Transfer; Retrospective Studies; Treatment Outcome

Topics: Administration, Inhalation; Administration, Oral; Budesonide; Child, Preschool; Croup; Dexamethasone; Emergency Medicine; Evidence-Based Medicine; Glucocorticoids; Hospitalization; Humans; MEDLINE; United States

As many as 3% of children under six years of age are affected by croup, usually at two to three years. Symptoms include a barking cough and inspiratory stridor. The preceding infection of the larynx is usually viral; bacterial infection can complicate the condition. Mist inhalation has been the traditional treatment. Dexamethasone and now budesonide may be used as first-line treatment.

Topics: Aerosols; Anti-Inflammatory Agents; Budesonide; Child, Preschool; Cough; Croup; Dexamethasone; Humans; Pediatric Nursing

Topics: Administration, Topical; Anti-Inflammatory Agents; Budesonide; Child, Preschool; Croup; Female; Glucocorticoids; Hospitalization; Humans; Infant; Male; Pregnenediones

Topics: Administration, Inhalation; Administration, Topical; Anti-Inflammatory Agents; Bronchodilator Agents; Budesonide; Child, Preschool; Croup; Glucocorticoids; Humans; Nebulizers and Vaporizers; Pregnenediones

Topics: Administration, Topical; Aerosols; Anti-Inflammatory Agents; Budesonide; Child; Croup; Epinephrine; Glucocorticoids; Humans; Pregnenediones