Role of corticosteroids in pseudo-croup

AIM: There is consensus about the effectiveness of corticosteroids in the treatment of moderate and severe pseudo-croup (subglottic laryngitis). The aim of this study was to establish which corticosteroid is to be preferred, and at which dose and by which route of administration. A secondary aim was to determine the effect of corticosteroids as treatment for mild pseudo-croup. METHOD: The Cochrane review from 2004 (Glucocorticoids for croup) and more recent articles, retrieved from PubMed, were reviewed. RESULTS: A placebo-controlled study showed a significant benefit of corticosteroids compared with placebo in the treatment of moderate pseudo-croup. Five other studies showed, except for one, that different corticosteroids, in different doses, are effective in the treatment of moderate and severe pseudo-croup. A placebo-controlled study of corticosteroids in the treatment of mild pseudo-croup showed corticosteroids to be significantly better than placebo; however, with number of return visits to the accident and emergency department, sleep deprivation, and parental stress as study outcomes, the clinical relevance of the findings is limited. CONCLUSIONS: Corticosteroids are effective in the treatment of moderate and severe pseudo-croup. On the basis of the various studies, we recommend a single oral dose of dexamethasone (0.15 mg/kg) for moderate pseudo-croup (croup score 3-5), but a budesonide nebulizer appears to be a good alternative. Only a modest response can be expected when corticosteroids are used to treat mild pseudo-croup (croup score 0-2).