Abstract / Summary
Abstract Purpose: Recurrent croup is a common cause of repeated healthcare utilisation in children. Although corticosteroids are widely used in acute croup, their role in reducing hospital attendance and improving outcomes in recurrent croup remains unclear.
Methods: A systematic literature search was conducted across major medical databases. Studies were selected using predefined PICO-based inclusion and exclusion criteria and a PRISMA-guided screening process. Studies evaluating inhaled or systemic corticosteroids in children with recurrent croup were included. Primary outcomes were hospital admission and re-attendance rates. Secondary outcomes included croup severity scores, symptom improvement, and adverse effects.
Results: Of 432 records identified, eight studies met the inclusion criteria, comprising six randomised controlled trials and two observational studies. Inhaled steroid use was associated with reduced hospital admission rates and improved clinical outcomes compared with placebo. Improvements in croup severity scores and symptom burden were observed with both inhaled and systemic corticosteroids. Systemic corticosteroids were associated with lower admission and re-admission rates than placebo and inhaled treatments. Among inhaled therapies, budesonide was associated with lower re-admission rates than dexamethasone.
Conclusion: High-quality evidence from randomised controlled trials and systematic reviews supports the use of corticosteroids in acute croup, demonstrating consistent benefits across multiple clinically relevant outcomes. In contrast, evidence for recurrent croup remains limited and is predominantly observational. While inhaled steroids appear to reduce admissions and improve symptom severity, their role in preventing recurrent croup remains investigational. Further prospective studies are required to establish the optimal corticosteroid regimen and define the role of early home-based inhaled therapy.