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The efficacy of nebulized budesonide in dexamethasone-treated outpatients with croup
T P Klassen1, L K Watters, M E Feldman
1Department of Pediatrics, University of Ottawa, Ontario, Canada.
Insights
Nebulized budesonide offers added clinical benefit for children with mild to moderate croup, improving respiratory symptoms when given with oral dexamethasone. This treatment shows a significant improvement in croup scores within four hours.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Illnesses
- Pharmacology
Background:
- Croup is a common respiratory illness in young children, characterized by a barking cough and stridor.
- Dexamethasone is a standard treatment for croup, but its effectiveness can be enhanced.
- Nebulized budesonide is an inhaled corticosteroid that may offer additional benefits.
Purpose of the Study:
- To evaluate the additional clinical benefit of nebulized budesonide in children with mild to moderate croup.
- To compare the efficacy of nebulized budesonide plus oral dexamethasone versus oral dexamethasone alone.
Main Methods:
- A randomized, double-blind, placebo-controlled trial was conducted in a pediatric emergency department.
- Children aged 3 months to 5 years with mild to moderate croup received oral dexamethasone.
- Participants were randomly assigned to receive either nebulized budesonide or a placebo.
Main Results:
- Eighty-four percent of patients receiving nebulized budesonide showed clinically important improvement, compared to 56% in the placebo group.
- The number needed to treat with nebulized budesonide for one additional patient to benefit was four.
- Clinically important improvement was defined as a two-point decrease in the croup score within 4 hours.
Conclusions:
- Nebulized budesonide provides added clinical benefit in pediatric patients with mild to moderate croup, even when oral dexamethasone is administered concurrently.
- Inhaled budesonide is an effective adjunctive therapy for improving respiratory symptoms in croup.
- This study supports the use of nebulized budesonide as part of croup management in the emergency department.
Objective:
To determine the added clinical benefit of nebulized budesonide in children with mild to moderate croup treated with 0.6 mg/kg oral dexamethasone.
Design:
Randomized, double-blind, placebo-controlled trial.
Setting:
Emergency department of a tertiary-care pediatric hospital with 47,000 visits per year.
Participants:
Children 3 months to 5 years of age with a syndrome consisting of hoarseness, inspiratory stridor, and barking cough and a croup score of 3 or greater after at least 15 minutes of mist therapy. Patients were excluded from the study if they had diagnoses of epiglottitis, chronic upper or lower airway disease (not including asthma), or severe croup or had received corticosteroids within the preceding 2 weeks.
Intervention:
All patients received 0.6 mg/kg oral dexamethasone and were randomly assigned to receive 4 mL (2 mg) of budesonide solution (n=25) or 4 mL of 0.9% saline solution (n=25) by updraft nebulizer with a continuous flow of oxygen at 5 to 6 L/min.
Main Outcome Measures:
The primary outcome measure was the proportion of patients in each group who had clinically important changes (two points) in the croup score during the 4 hours after treatment.
Results:
Eighty-four percent (n=21) of the patients who received budesonide had clinically important responses, compared with 56% (n=14) in the placebo group. The number of patients who would need to be treated with nebulized budesonide for one patient to have a clinically important response is four patients.
Conclusions:
Despite receiving simultaneous oral dexamethasone, pediatric outpatients with mild to moderate croup have added, clinically important improvement in respiratory symptoms after treatment with budesonide.