Scientific Rationale for the Use of Alpha-Adrenergic Agonists and Glucocorticoids in the Therapy of Pediatric Stridor

Table 3

Clinical effects of αAR-agonists and glucocorticoids in viral-induced stridor.

Treatment modality	Clinical outcomes
αAR-agonists	(i) Transient improvements in croup symptom scores compared to placebo at 10 and 30 minutes after administration (duration 120 minutes)
(i) Nebulized racemic epinephrine; (ii) Nebulized (L) isomeric epinephrine	(ii) Shorter hospital stay
Glucocorticoids
(i) Dexamethasone (0.15–0.6 mg/kg)*	(i) Significant improvement in croup symptom scores, starting about an hour after administration
(ii) Nebulized budesonide (2–4 mg)	(ii) Sustained effect in croup symptom scores (peak 6–12 hours after administration)
(iii) Betamethasone (0.4 mg/kg/dose)	(iii) Decreased number of return visits or (re)admissions
(iv) Prednisolone (1 mg/kg/dose)	(iv) Decreased length of time spent in the hospital

^*The majority of large randomized clinical trials have been conducted with dexamethasone, but there is clinical evidence suggesting equivalent responses with other glucocorticoids used in viral-induced stridor.