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April 1996

Corticosteroids for CroupReconciling Town and Gown

Arch Pediatr Adolesc Med. 1996;150(4):344-346. doi:10.1001/archpedi.1996.02170290010001

AFTER SEVERAL decades of controversy, the efficacy of glucocorticoid therapy for children with croup is now substantiated by a consistent body of evidence from randomized controlled trials. Younger clinicians may not appreciate the acrimonious tenor of the corticosteroid-croup debate. As Smith1 wrote in 1989, "For many years, controversy has been the rule concerning this form of therapy, with battle lines drawn that have primarily, but not exclusively, separated the practitioner and the academician." In general, practitioner opinion favored and academician opinion opposed corticosteroids for croup.

In hindsight, clues about the efficacy of glucocorticoids were present from an early time. One of the first published comparative studies outlined most of the subsequently demonstrated benefits of glucocorticoids in this disease.2 A cumulative meta-analysis of the data (Figure) shows that by 1966, glucocorticoids were responsible for clinical improvement 12 hours after treatment (odds ratio, 2.36; 95% confidence interval, 1.75 to 3.18).