Budesonide Offers No Advantage When Added to Oral Dexamethasone in the Treatment of Croup

OBJECTIVE: To evaluate the effect of adding inhaled budesonide (2 mg) to oral dexamethasone 0.15 mg/kg in children hospitalized with croup. SETTING: Observation ward of a Tertiary Paediatric Hospital Emergency Department. SUBJECTS: Seventy-two children (age range 3 to 126 months) hospitalized with croup. INTERVENTION: Children randomized to receive either 2 mg of nebulized budesonide or placebo, with all children receiving a single oral dose of 0.15 mg/kg dexamethasone. OUTCOME MEASURES: Primary outcome was duration of hospital stay. Other measures included croup scores from 0 to 12 hours, use of nebulized epinephrine, duration of croup symptoms, duration of viral symptoms, and return to medical care for croup or for any other reason following discharge from hospital. RESULTS: Baseline characteristics for the 2 groups were similar. There was no difference in time to discharge for the 2 groups or for other outcome measures with a risk ratio of 1.3 (95% confidence intervals of 0.82 and 2.1). CONCLUSIONS: The addition of inhaled budesonide (2 mg) to oral dexamethasone (0.15 mg/kg) offers no advantage in the treatment of children hospitalized with croup.