From the Guidelines
The current treatment for laryngotracheobronchitis (croup) with wheezing involves a combination of medications, including dexamethasone and inhaled bronchodilators, to address both upper airway inflammation and lower airway bronchospasm. The first-line treatment includes dexamethasone (0.6 mg/kg, maximum 16 mg) given as a single oral dose, which reduces inflammation in the larynx and trachea 1. For significant respiratory distress, nebulized epinephrine (such as 0.5 ml/kg of a 1:1000 solution) provides rapid but temporary relief of airway edema, as noted in the British Thoracic Society guidelines 1. However, the most recent study from 2022 suggests that improvements in treatment protocols can lead to reduced hospital admissions for croup, emphasizing the importance of evidence-based treatment approaches 1. When wheezing is present, inhaled bronchodilators such as albuterol should be administered every 4-6 hours as needed to relieve bronchospasm. Key considerations in managing croup with wheezing include:
- Humidified air or oxygen for symptomatic relief
- Hospitalization for children with significant respiratory distress, hypoxemia, or inability to maintain hydration
- Parental advice to seek immediate medical attention if the child develops increased work of breathing, lethargy, or inability to drink fluids Given the recent study from 2022, the focus should be on implementing evidence-based clinical guidelines to reduce hospital admissions and improve outcomes for children with croup 1.
From the Research
Current Treatment for Laryngotracheobronchitis (Croup) with Wheezing
- The current treatment for croup with wheezing typically involves the use of corticosteroids, such as dexamethasone, to reduce inflammation and alleviate symptoms 2, 3, 4.
- A single dose of orally administered dexamethasone (0.15-0.6 mg/kg) is often used as the mainstay of treatment, with the addition of nebulized epinephrine in cases of moderate to severe croup 4.
- Nebulized budesonide (2 mg) can be given as an alternative to oral dexamethasone for children who do not tolerate it 2, 4.
- Heliox, a mixture of helium and oxygen, may be used to relieve respiratory distress in children with moderate to severe croup, although the evidence for its effectiveness is limited and of low quality 5.
- Low-dose nebulized epinephrine (0.1 mg/kg) has been shown to be non-inferior to the conventional dose (0.5 mg/kg) in reducing croup scores in patients with moderate to severe croup 6.
Treatment Options
- Oral dexamethasone (0.15-0.6 mg/kg) 2, 3, 4
- Nebulized budesonide (2 mg) 2, 4
- Nebulized epinephrine (0.1-0.5 mg/kg) 3, 6
- Heliox (mixture of helium and oxygen) 5