Nebulised adrenaline is also useful

BMJ 1996;312:510 (24 February)

Letters

Nebulised adrenaline is also useful

EDITOR,--We are concerned that Iolo Doull's editorial¹ seemsto disregard the importance of nebulised adrenaline in childrenwith croup and that some general practitioners or even paediatriciansmay consequently consider steroids alone to be adequate managementfor those with moderate or severe airway obstruction. The safetyand efficacy of nebulised adrenaline with and without oral steroidshave been shown.² ³ The effect of nebulised adrenaline may berelatively short lived, but it usually provides prompt reliefof airway obstruction and in our experience has often preventedthe need for intubation, especially early after admission.

Clearly, a controlled clinical trial is needed to evaluate theeffect of nebulised budesonide compared with that of nebulisedadrenaline. Both are effective forms of treatment but differin their mode of action and their place in the management ofcroup.

Consultant paediatrician Consultant paediatrician Epsom GeneralHospital, Epsom, Surrey KT19 8PB

M Cronin, R Diedericks