title: Nebulized budesonide and oral dexamethasone for treatment of croup: a randomized controlled trial.
abstract: BACKGROUND
  The effectiveness of glucocorticoids for patients with croup is well established but it remains uncertain which glucocorticoid regimen is most effective.
  
  
  OBJECTIVE
  To determine the effectiveness of 3 glucocorticoid regimens in patients with croup.
  
  
  METHODS
  Randomized controlled trial with parallel design.
  
  
  METHODS
  Emergency departments of 2 Canadian pediatric tertiary care hospitals.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, University of Ottawa, Ontario, Canada. terry.klassen@sympatico.ca
authors.forename: T P
authors.initials: TP
authors.lastname: Klassen
authors.forename: W R
authors.initials: WR
authors.lastname: Craig
authors.forename: D
authors.initials: D
authors.lastname: Moher
authors.forename: M H
authors.initials: MH
authors.lastname: Osmond
authors.forename: H
authors.initials: H
authors.lastname: Pasterkamp
authors.forename: T
authors.initials: T
authors.lastname: Sutcliffe
authors.forename: L K
authors.initials: LK
authors.lastname: Watters
authors.forename: P C
authors.initials: PC
authors.lastname: Rowe
mesh_terms: D000281:Administration, Intranasal; D000284:Administration, Oral; D019819:Budesonide / Q000008:administration & dosage* / Q000627:therapeutic use; D002675:Child, Preschool; D003440:Croup / Q000188:drug therapy*; D003907:Dexamethasone / Q000008:administration & dosage* / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D009330:Nebulizers and Vaporizers; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D019819:Budesonide; D003907:Dexamethasone