Correspondence

Aerosolized Corticosteroids for Croup

N Engl J Med 1995; 332:400February 9, 1995

Article

To the Editor:

In their editorial (Aug. 4 issue),1 Drs. Landau and Geelhoed state that with corticosteroid treatment “intubated children can be extubated earlier.” They refer to a report on a well-controlled study,2 the senior author of which is Dr. Landau. Unfortunately, they fail to cite another well-controlled study,3 which came to the opposite conclusion. Thus, they give readers the impression that corticosteroid prophylaxis is the state of the art for pediatric extubation, whereas it is actually a controversial therapy. The Journal's editorials are highly respected sources of information on the state of the art and must represent the various points of view concerning issues on which the authors choose to take a position.

Yaron Harel, M.D.
Daniel L. Levin, M.D.
Children's Medical Center, Dallas, TX 75235

3 References

1. 1

   Landau LI, Geelhoed GC. Aerosolized steroids for croup. N Engl J Med 1994;331:322-333
   Full Text | Web of Science | Medline

2. 2

   Tibballs J, Shann FA, Landau LI. Placebo-controlled trial of prednisolone in children intubated for croup. Lancet 1992;340:745-8
   

3. 3

   Tellez DW, Galvis AG, Storgion SA, Amer HN, Hoseyni M, Deakers TW. Dexamethasone in the prevention of postextubation stridor in children. J Pediatr 1991;118:289-294
   CrossRef | Web of Science | Medline

Author/Editor Response

Dr. Landau replies:

To the Editor: Drs. Harel and Levin raise an important issue regarding the role of corticosteroid treatment in children before extubation. In our editorial on corticosteroids for croup, we refer to a study that demonstrated earlier extubation with the use of corticosteroids in children intubated for croup.1 The study by Tellez et al.2 found that the routine use of corticosteroids did not reduce the incidence of postextubation stridor in children with a variety of conditions, none of which were croup. Many of these children had undergone prolonged intubation, 40 percent had trauma, and 60 percent had circulatory compromise. Studies in animals suggest that corticosteroids could be helpful in such patients, but no properly controlled clinical studies have supported this idea. The authors of the report state that their study did not, in fact, address the efficacy of corticosteroids in children with selected clinical presentations. There is evidence of the efficacy of corticosteroids in children intubated for croup, but this observation cannot be generalized to apply to children intubated for other conditions.

Louis I. Landau, M.D.
Princess Margaret Hospital for Children, Perth 6001, Australia

2 References

1. 1

   Tibballs J, Shann FA, Landau LI. Placebo-controlled trial of prednisolone in children intubated for croup. Lancet 1992;340:745-748
   CrossRef | Web of Science | Medline

2. 2

   Tellez DW, Galvis AG, Storgion SA, Amer HN, Hoseyni M, Deakers TW. Dexamethasone in the prevention of postextubation stridor in children. J Pediatr 1991;118:289-294
   CrossRef | Web of Science | Medline

Citing Articles (3)

Citing Articles

1. 1

   Kelly F Russell, Yuanyuan Liang, Kathleen O'Gorman, David W Johnson, Terry P Klassen, Terry P Klassen. 2011. Glucocorticoids for croup. .
   CrossRef

2. 2

   Kelly F Russell, Natasha Wiebe, Antonio Saenz, Monica Ausejo Segura, David W Johnson, Lisa Hartling, Terry P Klassen, Terry P Klassen. 2004. Glucocorticoids for croup. .
   CrossRef

3. 3

   Segura M Ausejo, A Saenz, B Pham, JD Kellner, DW Johnson, D Moher, TP Klassen. 1999. Glucocorticoids for croup. .
   CrossRef