pulmicort and Cyanosis

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

Subglottic laryngitis is one of the acute children's diseases, directly caused by a violently growing edema of the subglottic area. Its symptoms generally appear very suddenly, when children seem to be in perfect health, at night, several hours after falling asleep. Their symptoms included barking cough, clear voice, stridor, inspiratory dyspnoea with participation of auxiliary respiratory muscles, excitation and anxiety of a child, changes in skin coloration. The movement of the wings of the nostrils is intensified. In especially severe cases, agitation, cyanosis, pallor of skin, obnubilation, apnea, loss of consciousness and circulatory failure may also occur. Subglottic laryngitis is a disease, which can threaten the life of a small child. The aim of this study was to observe efficacy of the treatment of the subglottic laryngitis with glucocorticoids, especially budesonide in nebulization. The research covered 169 children: 58 girls (34.31%) and 111 boys (65.69%) aged 9. months do 5. years (mean 3 years 6 months) hospitalized in the Children's Hospital in Warsaw with the following symptoms: dry barking cough, stridor, inspiratory dyspnoea with the participation of auxiliary respiratory muscles, agitation and change of colour of skin. The examination of each patient included subjective, objective (pediatric and laryngological). 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 scale. The results indicate that nebulised budesonide can be used as a safe and effective alternative treatment in children with moderate to severe subglottic laryngitis.

Topics: Administration, Inhalation; Budesonide; Child, Preschool; Cough; Cyanosis; Dyspnea; Female; Glucocorticoids; Humans; Infant; Laryngitis; Male; Respiratory Sounds; Severity of Illness Index; Treatment Outcome