Croup. A current perspective.

In the past decade, much progress has been made in the management of patients with croup. Where glucocorticoids have been adopted into practice, evidence shows that a decrease of health-care-service use is occurring in terms of fewer admissions to intensive care units and hospitals. The evidence may be summarized as follows. All children with croup symptoms who demonstrate increased work of breathing in the clinics or emergency departments should be treated with glucocorticoids. This treatment may be with nebulized budesonide (2 mg) or PO or IM dexamethasone (dose may be 0.15-0.6 mg/kg). Oral dexamethasone may be the best option because of its ease of administration, widespread availability, and lower cost. L-Epinephrine (5 mL of 1:1000) or racemic epinephrine (0.5 mL) should be considered for children with croup who have moderate or severe distress. No evidence supports the effectiveness of mist therapy, and physicians are in need of a randomized, controlled trial for this.