Dexamethasone Use in Barking Cough in Adults
Dexamethasone is not routinely recommended for the treatment of barking cough (croup) in adults, as there is insufficient evidence supporting its use in the adult population despite its established efficacy in pediatric croup. 1
Understanding Barking Cough in Adults
A barking cough in adults typically represents one of several conditions:
- Acute laryngotracheitis (viral croup-like illness) 1
- Post-viral inflammation of the upper airways 1
- Reflux-associated laryngeal irritation 1
- Upper airway pathology 1
Diagnostic Approach
Before considering treatment with dexamethasone, proper evaluation should include:
- Detailed history focusing on onset, duration, and associated symptoms 1
- Physical examination concentrating on the upper airway 1
- Chest radiograph and spirometry to rule out other causes 1
- Assessment of symptom severity using visual analog scales 1
Evidence for Corticosteroid Use
The evidence for dexamethasone in adult barking cough is limited:
- Most research on corticosteroids for croup focuses on pediatric populations 2, 3
- Pediatric evidence shows dexamethasone reduces symptoms, return visits, and hospitalizations in croup 3, 4
- The standard dose in pediatric croup is 0.6 mg/kg (maximum 10-12 mg) 2
- In adults, there is insufficient evidence to recommend routine use of corticosteroids for cough without a clear inflammatory etiology 1
Treatment Considerations
If considering dexamethasone for an adult with a barking cough:
- First rule out other causes requiring specific treatment (GORD, asthma, post-nasal drip) 1
- Consider a trial of oral corticosteroids only if there is suspected eosinophilic airway inflammation 1
- A negative response to a two-week oral steroid trial effectively rules out eosinophilic airway inflammation as a cause 1
- For upper airway symptoms, topical corticosteroids may be more appropriate than systemic dexamethasone 1
Potential Alternative Approaches
Other treatment options that should be considered before dexamethasone:
- For reflux-associated cough: Intensive acid suppression with proton pump inhibitors and alginates for at least 3 months 1
- For upper airway pathology: Topical corticosteroids for rhinosinusitis 1
- For smoking-related cough: Smoking cessation 1
- For ACE inhibitor-induced cough: Discontinuation of the medication 1
Monitoring and Follow-up
If dexamethasone is used:
- Treatment effects should be formally quantified 1
- Monitor for resolution of symptoms 1
- Assess need for additional treatments 1
- Consider referral to specialist cough clinic if symptoms persist 1