No difference between oral and nebulised steroids in croup

Date First Published:
March 1, 2000
Last Updated:
December 20, 2002
Report by:
Sue Maurice, Consultant in Emergency Medicine (Manchester Royal Infirmary)
Search checked by:
Terry Gilpin, Manchester Royal Infirmary
Three-Part Question:
In [a child with croup] is [oral dexamethazone better than nebulised budesonide] at [reducing length of stay and reducing croup score]?
Clinical Scenario:
A 3 year old child attending the emergency department with moderately severe croup. I know that croup responds to steroid therapy, but I want to know whether oral dexamethasone is a better treatment than nebulised budesonide.
Search Strategy:
Medline 1996-Nov/02 using the OVID interface.
Search Details:
[exp croup OR croup ti.ab.sh OR laryngotracheitis ti.ab.sh OR laryngotracheobronchitis ti.ab.sh] AND [budesonide ti.ab.sh OR dexamethasone ti.ab.sh]
Outcome:
111 papers found of which 63 were irrelevant. The remaining paper is shown in the table.
Relevant Paper(s):
Study Title Patient Group Study type (level of evidence) Outcomes Key results Study Weaknesses
Oral and inhaled steroids in croup: a randomised, placebo controlled trial. Geelhoed GC, MacDonald WB. 1995, Australia 80 children (5-158 months) randomised to receive budesonide, dexamethasone or placebo PRCT Time to croup score less than 1 Significantly shorter for both steroid groups (2-3h) vs placebo (8h)
Duration of hospitilisation Significantly shorter for both steroid groups (12h) vs placebo (20h)
Author Commentary:
There is no significant difference in the clinical effectiveness of oral and nebulised steroids in croup. The effect of simple humidification has not been accounted for in this study.
Bottom Line:
Either oral dexamethasone or nebulised budesonide can be used to good effect in moderately severe croup. Dexamethasone is currently much cheaper.
References:
  1. Geelhoed GC, MacDonald WB.. Oral and inhaled steroids in croup: a randomised, placebo controlled trial.