Inhaled Epinephrine Gives Temporary Relief From Croup

Children's croup symptoms improve for up to two hours after treatment with epinephrine

MONDAY, March 7 (HealthDay News) -- Inhaled epinephrine improves moderate to severe croup symptoms in children from 30 minutes to two hours after treatment, according to a literature review published in the Cochrane Database of Systematic Reviews.

Candice Bjornson, M.D., of the Alberta Children's Hospital in Calgary, Canada, and colleagues evaluated eight studies comprising 225 participants to determine the efficacy and safety of nebulized epinephrine (NE) in children presenting to the emergency department or admitted to hospital with croup. The main outcome examined was the post-treatment change in croup score, and secondary outcomes included rate and duration of intubation and hospitalization, croup return visit, parental concern, and treatment side effects.

The researchers found that NE significantly improved the children's croup score 30 minutes post-treatment. While croup scores at two or six hours post-treatment were not significantly improved, children's symptoms were not worse than prior to treatment. Compared to a placebo, there was a significant association between NE and a shorter hospital stay. There was no benefit to delivering the NE by intermittent positive pressure breathing compared to nebulization alone at 30 minutes or two hours, nor was there evidence to favor racemic epinephrine over L-epinephrine. There were no studies that investigated the adverse effects of NE.

"Compared to no medication, inhaled epinephrine improved croup symptoms in children at 30 minutes following treatment," the authors write. "Few studies examined similar outcomes; therefore data could often not be pooled and conclusions are based on one or few studies."

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