Inhaled epinephrine quick and effective for childhood croup

A review from the Cochrane Library validates the use of nebulized epinephrine (NE) to quickly relieve symptoms of moderate to severe croup in children.

Croup, usually caused by viral infection, is characterized by hoarseness of the voice, barky cough, and varying degrees of noisy breathing, the result of swelling of the area of the trachea just below the larynx. Nebulized epinephrine given to children with more severe swelling causes a temporary shrinkage in the swollen area of the trachea to reduce the child’s difficulty in breathing and may help to prevent intubation.

Small studies previously have shown that NE relieves croup symptoms in 30 minutes. Researchers from the University of Calgary, Alberta, Canada, conducted a systematic review of 8 studies involving 225 children treated in a hospital or emergency department to confirm the safety and efficacy of this procedure.

Their review of trials of inhaled epinephrine found that, compared with no medication, NE significantly improved symptoms, including airway obstruction, in children with moderate and severe croup at 30 minutes after treatment. Nebulized epinephrine also was associated with a shorter hospital stay than placebo. The effect of NE was no longer evident at 2 hours, but no rebound effect was observed. No significant differences were found between racemic NE and L-epinephrine or between NE delivered by intermittent positive pressure breathing or nebulization alone.

The researchers concluded, “NE is associated with clinically and statistically significant transient reduction of symptoms of croup 30 minutes post-treatment.”

Bjornson C, Russell KF, Vandermeer B, Durec T, Klassen TP, Johnson DW. Nebulized epinephrine for croup in children. Cochrane Database Syst Rev. 2011;(2):CD006619.