The April issue of Drugs & Therapy Perspective presents information on current trends in rump therapy, namely the main role in the treatment of this corticosteroid condition.

Croup (laryngotracheobronchitis) is a common childhood illness characterized by hoarseness, barking cough and stridor. As a rule, the croup develops suddenly and also stops suddenly spontaneously, however, in severe cases, a potentially fatal obstruction of the upper respiratory tract may develop. Corticosteroids have a beneficial effect on the relief of croup symptoms and are therefore considered the drugs of choice in this condition. Currently, the use of corticosteroids is indicated as an emergency measure for the diagnosis of rump, whether or not the patient is hospitalized in the future. In addition to corticosteroids, humidified air inhalations (aerosol therapy) are used in combination with inhaling epinephrine (adrenaline).

Croup affects approximately 5.6% of children each year, mainly between the ages of 6 months and 3 years. The etiological factor of croup is considered to be a viral infection, for example parainfluenza viruses. Usually, a developed croupy state stops spontaneously within 3-7 days. However, severe laryngeal obstruction, requiring hospitalization, can sometimes develop.

Traditionally distinguish croup viral (progressive onset, previous fever and rhinorrhea) and spasmodic (occurs in older children, has a sudden onset without previous symptoms).

It is often clinically difficult to differentiate between these two forms. The diagnosis is usually made in a previously healthy child, and it is therefore important to exclude all other possible causes of airway obstruction in order to prescribe adequate treatment. The differential diagnosis is made with aspiration of foreign bodies, bacterial tracheitis, epiglottitis and pharyngeal abscess.

In the absence of absolute contraindications, corticosteroids are the drugs of choice in croup therapy. They have a beneficial effect, no matter how serious the process. In addition, in the treatment of croup, corticosteroids are used only once or for a short time, so the risk of developing their adverse reactions is minimal.

The most common corticosteroid used in the treatment of croup is dexamethasone (oral or intramuscular), which significantly improves the condition of patients with croup. The effect of the use of dexamethasone appears regardless of the route of administration chosen.

A dose of 0.6 mg / kg is generally used, but smaller doses of dexamethasone (0.15 mg / kg) have been shown to be quite sufficient to eliminate symptoms of croup. With the exception of cases of severe vomiting and the inability to take the fluid inside, oral dexamethasone can be considered the drug of choice.

An alternative to dexamethasone can be considered an aerosol of budesonide (1-2 mg). With its use, a noticeable improvement in the condition is quickly noted (within the first 2 to 6 hours), and the effect lasts up to 12 to 24 hours. With the appointment of budesonide, the frequency of hospitalizations and their duration decrease, and the number of patients requiring additional medical care decreases. Initially, the aerosolized hormone forms were thought to have a faster and safer effect than oral administration or IM injection of dexamethasone, but this is not confirmed by the results of clinical studies. In addition, aerosol therapy is more expensive for children.

In the treatment of croup, prednisone can also be used, especially in severe cases requiring intubation of the patient. However, with this disease, its effectiveness has not been sufficiently studied.

Corticosteroids are recommended for use as first aid. It is possible to recommend the use of single oral doses of corticosteroids in children at the diagnostic stage. Patients with moderately severe croup are much less likely to require repeat medical attention when prescribing small oral doses (0.15 mg / kg) of dexamethasone. Even in hospitalized patients, a marked improvement is often observed on admission to hospital, due to the rapid development of the effect (within one hour of drug administration), and, therefore, the need for hospital treatment can be reviewed.

An epinephrine aerosol (adrenaline) is currently rarely used. Its stopping effect on croup symptoms is associated with a decrease in tracheobronchial secretion and a decrease in swelling of the mucosa. The effect occurs 10 to 30 minutes after inhaling adrenaline. However, its effect is short-lived and manifestations of croup resume about 2 hours after using the drug. Therefore, such therapy can only be used under medical supervision of the patient. Patients may be released 2 to 4 hours after corticosteroid therapy and inhaled single dose epinephrine, provided there are no symptoms. In this category of patients, only very few of patients require repeat medical care within 24 to 48 hours. To date, the epatephrine racemate has been used in the treatment of croup. However, according to the latest data, the L-isomer of epinephrine is 30 times more active than dextrorotatory and at the same time has no secondary chronotropic effect, so that the use of L-epinephrine in the future is more promising. It is believed that additional therapy using humidified air eliminates the discomfort and prevents the inflamed larynx from drying out. However, in the literature, data on the real benefits of such events are insufficient.

From the above, it follows that corticosteroids are currently the drugs of choice to help patients with croup.