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.


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

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s