Steroids in the management of croup

BMJ 1996;312:510 (24 February)

Letters

Steroids in the management of croup

Croup scores are rarely used in general practice

EDITOR,--Iolo Doull's recommendations about the role of steroidsin the management of croup are controversial and deserve comment.¹An earlier publication that reviewed essentially the same reportswas much more circumspect in its recommendations about nebulisedsteroids.²

There is now good evidence for a biological effect of oral,intravenous, and nebulised steroids in varying degrees of croup,but the evidence for a clinically important effect of nebulisedsteroids is less convincing. Studies relying on improvementsin the croup score (which assigns numbers to clinical signs)as the main outcome measure³ ⁴ can be criticised on the basisthat the validity, reliability, and responsiveness of the score(in all its various forms) have not been evaluated. Hence, whilethese studies have shown a significant difference between groupsgiven nebulised steroids and those given placebo, the extentto which these changes in the score reflect . . . [Full text of this article]