From the Guidelines
The most effective treatment for stridor following a cold is nebulized adrenaline (0.5 ml/kg of a 1:1000 solution) to avoid intubation and stabilize the patient, as recommended by the British Thoracic Society Nebulizer Project Group 1. This approach is particularly useful in cases where stridor is severe and requires immediate attention. The effect of nebulized adrenaline is short-lived, lasting 1–2 hours, and it should not be used in children who are shortly to be discharged or on an outpatient basis 1. For cases where nebulized adrenaline is not suitable, nebulised steroids (for example, 500 µg budesonide) may also reduce symptoms in croup in the first two hours 1. However, it's essential to note that the use of inhaled epinephrine for post-extubation stridor in conscious patients is suggested by some guidelines 1, but the most recent and relevant evidence for treating stridor following a cold supports the use of nebulized adrenaline as the primary treatment option. Key considerations in treating stridor following a cold include:
- Monitoring the patient's condition closely to determine the severity of the stridor
- Providing supportive care, such as cool mist or humid air, to reduce inflammation and ease breathing
- Using nebulized adrenaline or steroids as needed to manage symptoms
- Seeking immediate medical attention if symptoms persist, worsen, or are accompanied by other concerning signs, such as high fever, difficulty swallowing, or drooling.
From the Research
Treatment for Stridor Following a Cold
The treatment for stridor following a cold, particularly in the context of croup, involves several approaches.
- Nebulized racemic epinephrine has been shown to be effective in reducing the symptoms of croup, including stridor 2, 3.
- The use of oral dexamethasone in conjunction with nebulized racemic epinephrine and mist has been found to be safe and effective for outpatient treatment of croup, allowing for discharge after a period of observation 3.
- For patients requiring multiple doses of racemic epinephrine, inpatient treatment may be necessary, but the frequency and timing of clinically important interventions can vary, with some patients potentially being candidates for outpatient management 4.
- The cost-effective use of nebulized racemic epinephrine involves observing patients for 3 to 4 hours after treatment to determine if they can be safely discharged home, rather than automatically admitting them to the hospital 5.
- Alternatively, l-epinephrine aerosol has been found to be as effective as racemic epinephrine in treating postextubation laryngeal edema, and may be considered a less expensive and more widely available option 6.
Key Considerations
- The effectiveness of racemic epinephrine in treating croup symptoms, including stridor, has been demonstrated in several studies 2, 3, 4.
- The decision to discharge a patient or require inpatient treatment should be based on the patient's response to treatment and their overall clinical condition 3, 4, 5.
- The choice between racemic epinephrine and l-epinephrine may depend on factors such as cost, availability, and the specific clinical context 6.