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State of the Evidence for Standard-of-Care Treatments for
Croup: Are We Where We Need to Be?
James D. Cherry, MD, MSc
Background: Croup is a term that groups several different clinical
syndromeswith inspiratory stridor. The failure to delineate the
specific syndromes has led to suboptimal treatment in many instances.
Methods: A literature review and personal experience have been
analyzed.Results: Specific croup syndromes have been identified. Most croup
steroid-treatment studies have failed to adequately identify the
specific illness being treated. With 2 exceptions, all studiesdone to
date have been too small to sufficiently evaluate risks of steroids if
the risk is 1% or less.
Conclusions: Three conclusions were reached: (1) no steroid treatment
studies of moderate orsevere laryngotracheitis have been of
adequate size to determine the risk of progressive viral infection or
secondary bacterial infection; (2) single dose steroid treatment or
limited nebulized useis probably safe; and (3) we should encourage
better clinical diagnosis of croup illnesses.
Key Words: croup, spasmodic croup, laryngotracheitis,
(Pediatr Infect Dis J 2005;24: S198–S202)
The word “croup” is derived from the Anglo-Saxon word
kropan, meaning “to cry aloud.”1 Today croup is a broad,
clinical, diagnostic term used forseveral different respiratory
illnesses that have varying degrees of inspiratory stridor and
cough due to obstruction in the supraglottic, glottic and
subglottic regions (Table 1).1,2 Theclassification presented in
Table 1 notes specific illnesses by anatomic location, clinical
characteristics or etiology. Unfortunately during the past 30
years, there has been much confusion relating toterminology.
For example, papers entitled “Laryngotracheobronchitis”
usually discuss laryngotracheitis and spasmodic croup. In
addition, many papers about bacterial croup are entitled
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