Croup: Pharmacologic and supportive interventions
- Charles R Woods, MD, MS
Charles R Woods, MD, MS
- Professor of Pediatrics
- University of Louisville School of Medicine
Croup (laryngotracheitis) is a respiratory illness characterized by inspiratory stridor, barking cough, and hoarseness. It typically occurs in children six months to three years of age and is caused by parainfluenza virus. (See "Croup: Clinical features, evaluation, and diagnosis".)
The treatment of croup has changed significantly since the 1980s. Glucocorticoids and nebulized epinephrine have become the cornerstones of therapy. Substantial clinical evidence supports the efficacy of these interventions [1-5]. The impact also is evident in the decrease in annual hospital admissions for croup in children in the United States between 1979 to 1982 and 1994 to 1997 (from 2.8 to 2.1 per 1000 for children <1 year and from 1.8 to 1.2 per 1000 children for children 1 to 4 years) .
Treatment of croup may involve a variety of pharmacologic and nonpharmacologic interventions. It may occur entirely at home, or in the office, emergency department (ED), or hospital setting. Supportive and pharmacologic interventions will be discussed below. The clinical features and evaluation of croup and the approach to management are discussed separately. (See "Croup: Clinical features, evaluation, and diagnosis" and "Croup: Approach to management".)
Glucocorticoids provide long-lasting and effective treatment of mild, moderate, and severe croup [3,7-9]. The antiinflammatory actions of glucocorticoids are thought to decrease edema in the laryngeal mucosa of children with croup. Improvement is usually evident within six hours of administration but seldom is dramatic [7,10].
Treatment with glucocorticoids at various doses and by various routes has been shown to improve croup scores and to decrease unscheduled medical visits, length of stay in the emergency department or hospital, and the use of epinephrine . Among the available glucocorticoids, dexamethasone has been used most frequently, is the least expensive, has the longest duration of action, and is the easiest to administer.
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- Adverse effects
- - Dexamethasone
- - Budesonide
- - Prednisolone
- - Prednisone
- - Betamethasone
- Repeated dosing
- NEBULIZED EPINEPHRINE
- Racemic versus L-epinephrine
- MIST THERAPY
- OTHER THERAPIES
- INFORMATION FOR PATIENTS