Cold Air for Croup: Effectiveness in Alleviating Symptoms

Cold air is not effective in alleviating symptoms of croup in children and is not recommended as a treatment approach. 1, 2

Evidence on Cold Air for Croup

Current guidelines do not support the use of cold air for treating croup symptoms in children 1, 2
The American Academy of Pediatrics does not include cold air exposure in its treatment recommendations for croup 1
A systematic review found that humidified air, whether heated or cool, provides no additional symptom improvement for croup 3
Current evidence does not show any benefits from the use of heated or humidified air delivered for the treatment of respiratory symptoms 4

Oral corticosteroids are recommended for all cases of croup regardless of severity 1, 2
- Dexamethasone 0.15-0.6 mg/kg (maximum 10-12 mg) is the preferred medication 2
- Corticosteroids are highly effective in reducing the symptoms and inflammation of croup 3

Nebulized epinephrine is recommended for moderate to severe cases with stridor at rest or respiratory distress 1, 2
- Dosage: 0.5 ml/kg of 1:1000 solution (maximum 5 ml) administered by nebulizer 5
- The effect of nebulized epinephrine is short-lived, lasting approximately 1-2 hours 1, 5
- Patients should be monitored for at least 2 hours after administration to assess for rebound symptoms 1

Oxygen therapy should be administered to maintain oxygen saturation ≥94% 1, 5
Simple oxygen masks or tight-fitting non-rebreathing masks can be used as needed 1

Most croup cases are mild, with only 1-8% requiring hospital admission 6
Hospital admission should be considered when three or more doses of racemic epinephrine are required 1, 2
Limiting hospital admission until 3 doses of racemic epinephrine are needed can reduce hospitalization rates by 37% without increasing revisits 2
Bacterial tracheitis and foreign body aspiration are important differential diagnoses to consider when a patient fails to respond to standard croup treatment 2

Cold air exposure is not recommended as it lacks evidence for effectiveness 1, 3
Humidification therapy (mist/humidified air) has not been proven beneficial 6, 3
Corticosteroids from hand-held inhalers with spacer devices are not effective for croup 5
Nebulized epinephrine should not be used in children who are shortly to be discharged or on an outpatient basis due to risk of rebound symptoms 1, 5

Croup symptoms typically start like an upper respiratory tract infection, with low-grade fever and coryza followed by a barking cough and various degrees of respiratory distress 6
In most children, symptoms subside quickly with resolution of the cough within two days 6
Re-evaluate the child within 24 hours if symptoms persist 5
If symptoms worsen after initial improvement, prompt reassessment is necessary 5