Prospective Randomized Study Comparing L-epinephrine and Budesonide Aerosols in the Treatment of Moderate to Severe Croup

ABSTRACT

PURPOSE: The aim of this prospective, randomized study was to evaluate the effects and adverse effects of nebulized L-epinephrine compared with nebulized budesonide in children with moderate to severe croup. METHODS: Children were eligible for the study if their croup scores fell in the moderate to severe range(scores>4) in the AMC from May 1995 till May 1996. The patients were randomly assigned to receive either 5ml(1 1000) of L-epinephrine aerosols(n=9) or 500microgram of budesonide aerosols (n=8). Croup score, O2 saturation by pulse oximeter, heart rate, and blood pressure were recorded before treatment and at 5, 15, 30, 60, 120 minutes after aerosol treatment. Nine patients were enrolled in the nebulized L-epinephrine group and 8 in the nebulized budesonide group, respectively. There were no statistical differences in age, sex and croup score before treatment between the two groups. RESULTS: Total croup score significantly decreased at 15 minutes after treatment in the L-epinephrine group(P<0.05) but at 120 minutes after treatment in the budesonide group(P<0.05). Treatment failed in 1(1/9) patient in the L-epinephrine group and 2(2/8) patients in the budesonide group, who received intramuscular dexamethasone injections. The rebound phenomenon at 120 minutes after treatment was found in 1 patient from both groups. There were no significant changes of heart rate and blood pressure before and after treatment in both groups. CONCLUSION: The treatment using nebulized L-epinephrine showed a more prompt clinical improvement than the treatment using nebulized budesonide and without any significant adverse effects. So it can be recommended for emergent management in children with moderate to severe croup.