Nebulized Budesonide Is as Effective as Nebulized Adrenaline in

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 mgI4 mL) or L-adrenaline (4 mgI4 mL) via nebulization. The primary outcome measure was change in the total croup symptom score. Results. Thirty-five children received budesomde and 31 received adrenaline. There was no significant difference in baseline features, including croup score (mean [95% confidence interval]: budesonide, 7.1 [6.77.51; adrenaline, 7.7 [7.3-8.1]). All patients had significant improvement from baseline, and there was no 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. Conclusion. 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. Pediatrics 199697:722-725; adrenaline, budesonide, croup. Considerable debate has ensued regarding the efficacy of these treatments because of the variable and generally self-limiting course of the illness.” 1’ Recently, nebulized budesonide has been shown to be superior to nebulized saline (placebo) in children presenting at hospitals with mild to moderate4 and moderate to severe’2 croup. In both studies, the superiority of budesomde over the placebo was demonstrated within 2 to 4 hours.’2’4 However, it is not known whether budesomde is as efficacious as nebulized L-adrenahne in children with moderately Severe croup. Therefore, we performed a randomized, doubleblind, parallel group study of 24 hours’ duration in children hospitalized with viral or spasmodic croup to compare nebulized adrenaline with nebulized budesonide, using a validated croup symptom