Practice Based Learning: Does pulmicort (budesonide) help in croup?

Casey Ward, MD

Presented by Casey Ward, MD

Key points:

  • In doses of 1-4 mg, budesonide does not affect markers of systemic corticosteroid activity
  • Budesonide is better than placebo at preventing admission for croup in mild to moderate cases
  • Patients treated with epinephrine have significantly less stridor than those treated with budesonide
  • Children treated with dexamethasone and nebulized budesonide have better clinical response than those treated with dexamethasone and nebulized saline

Bottom line:

Epinephrine and dexamethasone are still the gold standards for treatment of stridor at rest in children with croup. Budesonide is a safe drug. In doses 4 mg or below, there does not appear to be any systemic steroid effect.  The evidence is not conclusive whether budesonide helps in an additive fashion when used with dexamethasone or epinephrine.

References:

Cetinkaya F, Tufekci BS, Kutluk G. “A comparison of nebulized budesonide, and intramuscular, and oral dexamethasone for treatment of croup”. Int J Pediatr Otorhinolaryngol. 2004. 68: 453-456.

Fitzgerald D, Mellis C, Johnson M, et al. “Nebulized Budesonide Is as Effective as Nebulized Adrenaline in Moderately Severe Croup”. Pediatrics 1996. 97(5): 722-725.

Geelhoed, GC. “Budenoside Offers No Advantage When Added to Oral Dexamethasone in the Treatment of Croup”. Pediatric Emergency Care 2005. 21(6): 359-362

Johnson DW, Jacobson S, Edney PC et al. “A comparison of nebulized budesonide, intramuscular dexamethasone, and placebo for moderately severe croup”. NEJM 1998. 339 (8): 498-503.

Klassen TP, Feldman ME, et al. “Nebulized budesonide for children with mild-to-moderate croup”. NEJM 1994. 331(5): 285-289.

Klassen TP, Watters LK, Feldman ME et al. “The efficacy of nebulized budesonide in dexamethasone-treated outpatients with croup”. Pediatrics 1996. 97(4): 463-466.

One thought on “Practice Based Learning: Does pulmicort (budesonide) help in croup?

  1. Pingback: Budesonide for treatment of croup (Updated – July 2015.) | Pediatric Focus

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