크루프의 약물치료 = Pharmacological treatment of the patients with croup

다국어 초록 (Multilingual Abstract)

Background: Croup is a respiratory illness usually caused by acute viral infection of the larynx, trachea, and bronchi, and characterized by the abrupt onset of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction. Croup commonly affects children younger than 6 years of age, with peak incidence between 7 and 36 months. Although the disease is usually self-limited, it may occasionally become life threatening, and can, on rare occasion, lead to respiratory failure.
Current Concepts: Treatment of viral croup depends on the severity of symptoms as denoted by Westley croup score (i.e., mild, moderate, or severe). A single dose of oral or intramuscular dexamethasone (0.15-0.6 mg/kg) is the mainstay of treatment for viral croup, irrespective of severity. A single dose of nebulized budesonide (2 mg) is equally effective as systemically administered dexamethasone, and is considered when a patient is unable to take a medicine orally.
Nebulized L-epinephrine (1:1,000, 3-5 mL) causes vasoconstriction in the mucosa, rapidly reducing airway edema.
Addition of nebulized L-epinephrine is indicated in the patients with croup of at least moderate severity, displaying chest retraction and signs of labored breathing.
Discussion and Conclusion: The most effective pharmacological treatments for patients with viral croup are oral or intramuscular dexamethasone, and nebulized L-epinephrine. Especially, corticosteroids can significantly decrease the intensity of croup symptoms and reduce hospital admissions, return visits to emergency department and length of stay in the hospital.

참고문헌 (Reference)

1 김은진, "후두기관지폐렴으로 진단된 소아 환자들의 임상 양상과 원인: 크룹 환아와의 비교" 대한 소아알레르기 호흡기학회 5 (5): 274-279, 2017

2 이용주, "소아 크룹 입원 환자의 병인과 계절적 변동: 6년간의 다기관 후향적 연구(2010–2015년)" 대한 소아알레르기 호흡기학회 7 (7): 78-85, 2019

3 Petrocheilou A, "Viral croup : diagnosis and a treatment algorithm" 49 : 421-429, 2014

4 Durward AD, "The outcome of patients with upper airway obstruction transported to a regional paediatric intensive care unit" 157 : 907-911, 1998

5 Soleimani G, "The comparison of oral and im dexamethasone efficacy in croup treatment" 4 : 175-178, 2013

6 Garbutt JM, "The comparative effectiveness of prednisolone and dexamethasone for children with croup: a community-based randomized trial" 52 : 1014-1021, 2013

7 Kairys SW, "Steroid treatment of laryngotracheitis : a meta-analysis of the evidence from randomized trials" 83 : 683-693, 1989

8 Waisman Y, "Prospective randomized double-blind study comparing L-epinephrine and racemic epinephrine aerosols in the treatment of laryngotracheitis(croup)" 89 : 302-306, 1992

9 Sparrow A, "Prednisolone versus dexamethasone in croup : a randomised equivalence trial" 91 : 580-583, 2006

10 Parker CM, "Prednisolone versus dexamethasone for croup : a randomized controlled trial" 144 : e20183772-, 2019

11 Rittichier KK, "Outpatient treatment of moderate croup with dexamethasone : intramuscular versus oral dosing" 106 : 1344-1348, 2000

12 Kliegman RM, "Nelson textbook of pediatrics" Elsevier 2020

13 Westley CR, "Nebulized racemic epinephrine by IPPB for the treatment of croup : a double-blind study" 132 : 484-487, 1978

14 Bjornson C, "Nebulized epinephrine for croup in children" (10) : CD006619-, 2013

15 Klassen TP, "Nebulized budesonide and oral dexamethasone for treatment of croup : a randomized controlled trial" 279 : 1629-1632, 1998

16 Griffin S, "Nebulised steroid in the treatment of croup : a systematic review of randomised controlled trials" 50 : 135-141, 2000

17 Lenney W, "Medicines used in respiratory diseases only seen in children" 34 : 531-551, 2009

18 agener JS, "Management of children hospitalized for laryngotracheobronchitis" 2 : 159-162, 1986

19 Donaldson D, "Intramuscular versus oral dexamethasone for the treatment of moderate-to-severe croup: a randomized, double-blind trial" 10 : 16-21, 2003

20 Pedersen LV, "Inhaleret budesonid versus dexamethason i. m. til behandling af pseudocroup Inhaled budesonide versus intramuscular dexamethasone in the treatment of pseudo-croup" 160 : 2253-2256, 1998

21 Moore M, "Humidified air inhalation for treating croup : a systematic review and meta-analysis" 24 : 295-301, 2007

22 Dobrovoljac M, "How fast does oral dexamethasone work in mild to moderately severe croup? A randomized double-blinded clinical trial" 24 : 79-85, 2012

23 Moraa I, "Heliox for croup in children" 10 : CD006822-, 2018

24 Gates A, "Glucocorticoids for croup in children" (8) : CD001955-, 2018

25 Russell KF, "Glucocorticoids for croup" (1) : CD001955-, 2011

26 Lee JH, "Efficacy of low-dose nebulized epinephrine as treatment for croup : a randomized, placebo-controlled, double-blind trial" 37 : 2171-2176, 2019

27 Alshehr M, "Efficacy of a small dose of oral dexamethasone in croup" 16 : 65-72, 2005

28 Bjornson CL, "Croup" 371 : 329-339, 2008

29 de Benedictis FM, "Corticosteroids in respiratory diseases in children" 185 : 12-23, 2012

30 Fifoot AA, "Comparison between single-dose oral prednisolone and oral dexamethasone in the treatment of croup : a randomized, double-blinded clinical trial" 19 : 51-58, 2007

31 Cherry JD, "Clinical practice. Croup" 358 : 384-391, 2008

32 이두리, "Clinical characteristics of children and adolescents with croup and epiglottitis who visited 146 Emergency Departments in Korea" 대한소아청소년과학회 58 (58): 380-385, 2015