Nebulized budesonide is as effective as nebulized adrenaline in moderately severe croup.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Fitzgerald
D
D
Department of Respiratory Medicine, Royal Alexandra Hospital for Children.
Mellis
C
C
Johnson
M
M
Allen
H
H
Cooper
P
P
Van Asperen
P
P
D000287:Administration, Topical; D000322:Adrenergic Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000336:Aerosols; D000402:Airway Obstruction / Q000188:drug therapy; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001986:Bronchial Spasm / Q000150:complications; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019819:Budesonide; D002648:Child; D002675:Child, Preschool; D003440:Croup / Q000188:drug therapy* / Q000209:etiology / Q000821:virology; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005938:Glucocorticoids; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D007902:Length of Stay; D009330:Nebulizers and Vaporizers; D010100:Oxygen / Q000097:blood; D011282:Pregnenediones / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
D000322:Adrenergic Agonists; D000336:Aerosols; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D005938:Glucocorticoids; D011282:Pregnenediones; D019819:Budesonide; D010100:Oxygen; D004837:Epinephrine