Treatment of croup with glucocorticoids

Croup is a common upper airway disease in children that can range from mild and self-limiting to severe and fulminating. Typical treatment in the past has been mist therapy, although its effectiveness is still being debated. Studies have been published evaluating the efficacy of oral, nebulized, and intramuscular dexamethasone and nebulized budesonide, in a number of combinations and concentrations, in patients ranging in age from 3 to 72 months. The majority of the subjects in the studies were males and more than one-third of the patients in one study previously had croup. The studies have consistently pointed out that the use of oral, intramuscular, and nebulized steroids have been beneficial in patients with varying severity of croup. Nebulized budesonide has been shown to be effective, but is not currently available in the US. Based on this information, intramuscular or oral dexamethasone has been shown to be effective and, in some studies, safe and could be administered to patients presenting with moderate-to-severe croup.