Three Part Question
In a [child with croup] is [nebulised epinephrine or nebulised budesonide] more effective at [reducing croup score and length of stay]?
A 4 year old girl attends the emergency department with moderately severe croup. You have heard that croup responds to steroid therapy, but wonder whether it is more effective than nebulised epinephrine.
Medline 1966-11/00 using the OVID interface.
[(exp croup OR croup.mp OR exp tracheitis OR laryngotracheitis.mp OR laryngotracheobronchitis.mp OR Stridor.mp) AND (exp epinephrine OR adrenaline.mp OR exp budesonide OR budesonide.mp)] LIMIT to human AND english.
119 papers found of which 118 were irrelevant or of insufficient quality. The remaining paper is shown in the table.
|Author, date and country
||Study type (level of evidence)
|Fitzgerald D et al,|
|66 hospitalised children with viral or spasmodic croup.
Budesonide 2mg vs epinephrine 4mg||PRCT||Duration of croup attack in hours||31 vs 26 (not significant)||Sample size calculated to be 66 but only 53 completed the 24 hr study.
No follow up|
|Change in total croup symptom score||7.1[1.2] vs 7.7[1.1] (not significant)|
|Side effects||No significant difference|
This study shows that there are no significant clinical differences between the two treatments. In such a case the relative cost of the treatment is an important factor in deciding which should be prescribed.
[Web Editor comments] The small size of this study means that no conclusion can be drawn regarding the difference between these treatments.
Clinical Bottom Line
Nebulized epinephrine and nebulized budesonide are as effective as each other in moderately severe croup.
Level of Evidence
Level 3 - Small numbers of small studies or great heterogeneity or very different population.
- Fitzgerald D, Mellis C, Johnson M et al. Nebulized budesonide is as effective as nebulized adrenaline in moderately severe croup. Pediatr 1996;97:722-5.