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Centre for Evidence-
Based Medicine

Croup - Nebulized Budesonide reduces hospital admission in children with mild to moderate croup

Clinical Bottom Line

Nebulized budesonide compared with placebo reduces hospital admission and improves symptoms in children with mild to moderate croup.


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. .

Clinical Question

In children with mild to moderate croup does nebulized budesonide compared with placebo reduce the risk of hospital admission?

Search Terms

'explode CROUP/all subheadings' and 'BUDESONIDE*' and 'CLINICAL TRIAL IN PT*'

The Study

  1. Randomised, controlled trial of children with croup score of 2-7 (out of possible 17) seen in A&E department.
  2. Randomisation was concealed and children, parents and clinicians were blind to treatment.
  3. They performed an intention to treat analysis.
  4. Control group (N = 27; 27 analysed) : 4 ml nebulized normal saline.
  5. Experimental group (N = 27; 27 analysed) : 4 ml nebulized budesonide (2 mg).

The Evidence

Admission one week later
EER CER ARR (95% CI) NNT (95% CI)
1/27 = 0.4 7/27 = 0.26 0.22 (0.042 to 0.402) 5 (2 to 24)

Mean 2 point reduction in croup score in treatment group (p<0.05).


  1. The small number of patients studied produces wide confidence intervals.
  2. Watch for more recent studies on this topic.

Appraised By

O.Duperrex and R Gilbert; 27 Mar. 00

Expiry Date

March 2000