Therapy changes in the treatment of subglottic laryngitis: A 30-year experience in Croatia

Croup (viral laryngotracheitis, also referred to in some settings as subglottic laryngitis) can cause acute upper-airway obstruction and requires prompt management to prevent respiratory compromise. This study evaluated long-term changes in reported croup management in Croatia.

Questionnaires were distributed to pediatricians and otolaryngologists in multiple Croatian hospitals in 1993, 2003, 2013, and 2023. A standardized clinical vignette of a 2-year-old child with mild-to-moderate croup was used for the core longitudinal comparisons. Categorical variables are reported as n (%) by specialty and survey year. The primary endpoint was the proportion of respondents selecting nebulized racemic epinephrine for the index vignette; other therapies and management choices were secondary endpoints. Trends over time were assessed using the Cochran-Armitage test and interpreted as exploratory.

Over the 30-year period, the most notable change was the widespread adoption of nebulized racemic epinephrine (otolaryngologists: 3.3% in 1993 to 93.9% in 2023; pediatricians: 17.2% to 86.7%). Use of humidification showed a non-linear pattern, with an initial decline followed by a partial resurgence in both specialties. In contrast, use of antibiotics and antihistamines declined substantially in both groups. Corticosteroids, given systemically or by inhalation, remained a mainstay of treatment throughout the study period.

Over three decades, reported management of croup in Croatia moved closer to contemporary evidence-based practice, particularly through adoption of nebulized epinephrine and reduced use of antibiotics and antihistamines.