The Treatment of Croup with Nebulized Budesonide and Intramuscular Dexamethasone

ABSTRACT

PURPOSE: Steroids have anti-inflammatory effects which reduces inflammation and edema of the tissue. Thus, corticosteroids have been used for treatment of croup. The aim this study is to compare and assess the effects of intramuscularly injected dexamethasone and nebulized budesonide in treatment of moderate or severe croup. METHODS: Between July 1995 to June 1996, we have assessed 44 inpatients with croup syndrome, of which 20 patients have been treated by intramuscularly injected dexamethasone and 24 patients by nebulized budesonide. We measured the croup symptom scores and arterial oxygen saturation at initial, at 4 hours, 12 hours and 24 hours after treatment. RESULTS: The sex ratio and mean age of patients were 2.31 and 18.7 +/- 9.1 months in budesonide treatment group and 31 and 22.3 +/- 13.1 months in dexamethasone treatment group, respectively. There was no significant difference (P>0.05) among the two groups. In budesonide treatment group, the symptom scores were 7.5 +/- 4.5 at initial and 4.5 +/- 1.3 at 4 hours after treatment. These were statistically significant (P<0.005). In the dexamethansone treatment group, the symptom scores were 7.6 +/- 1.2 at initial and 5.1 +/- 1.2 at 4 hours after treatment. They were statistically significant (P<0.005). Arterial oxygen saturations were significantly different (P<0.005) between initial and 4 hours after treatment in both groups. There were no side effects in the budesonide treatment group. CONCLUSION: Nebulized budesonide has the same effects with intramuscularly injected dexamethasone in treatment of croup whether the severity is moderate or extreme. Therefore it should provide an effective means of treatment for moderate or severe croup patients without systemic side effects.