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Centre for Evidence-
Based Medicine

Therapy: Clinical Scenario

The practice nurse for a large health centre who is responsible for running the self-referral asthma clinic for children and young adults stops you (the GP) during the lunch break. She has just seen a 2 year old child in the morning clinic with a barking cough and, from the description his mother gives, what sounds like inspiratory stridor during the previous night. She arranged for the child to be reviewed in your evening surgery. She poses the question, in children with mild to moderate croup, does nebulised budesonide decrease the risk of hospital admission compared with placebo? During her lunch break, she has a look for articles on the use of nebulised budesonide in croup on Medline (using Winspirs).

She presents you with her search strategy and a research article and asks whether you are going to give the child nebulised budesonide. By the time you see the child that evening, he has a barking cough, mild inspiratory stridor and a hoarse voice.


  1. Will you give the child nebulised budesonide?
  2. Should you change local practice policy?

Search strategy for Croup - type in:

  1. explode CROUP/ all subheadings
  4. #1 and #2 and #3

You find the article: Klassen, T.P. Feldman, M.E. Watters, L.K. et al. Nebulized budesonide for children with mild to moderate croup. NEJM 1994; 331(5):285-289.

Read the article and decide:

  1. Is the evidence from this randomised trial valid?
  2. If valid, is this evidence important?
  3. If valid and important, can you apply this evidence in caring for your patient?

Continue to completed worksheet