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Friday, 16. May 2014

Nebulised epinephrine for croup in children

A current Cochrane review assessed the applicability of nebulised epinephrine versus placebo for practice in children with croup croup
Croup (or laryngotracheobronchitis) is a respiratory condition that is usually triggered by an acute viral infection of the upper airway. The infection leads to swelling inside the throat, which interferes with normal breathing and produces the classical symptoms of a "barking" cough, stridor, and hoarseness.
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Mädchen inhaliert mit dem PARI XLent

Croup Croup
Croup (or laryngotracheobronchitis) is a respiratory condition that is usually triggered by an acute viral infection of the upper airway. The infection leads to swelling inside the throat, which interferes with normal breathing and produces the classical symptoms of a "barking" cough, stridor, and hoarseness.
is a common disease in childhood characterized by barky cough, stridor stridor
Stridor is a high-pitched musical breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree. Stridor is a physical sign which is caused by a narrowed or obstructed airway.
, hoarseness and respiratory distress. Children with severe croup croup
Croup (or laryngotracheobronchitis) is a respiratory condition that is usually triggered by an acute viral infection of the upper airway. The infection leads to swelling inside the throat, which interferes with normal breathing and produces the classical symptoms of a "barking" cough, stridor, and hoarseness.
are at risk for intubation. Nebulised epinephrine may prevent intubation.

A current Cochrane review assessed the applicability of nebulised epinephrine versus placebo for practice in children with croup croup
Croup (or laryngotracheobronchitis) is a respiratory condition that is usually triggered by an acute viral infection of the upper airway. The infection leads to swelling inside the throat, which interferes with normal breathing and produces the classical symptoms of a "barking" cough, stridor, and hoarseness.
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Eight studies (225 participants) were included. Epinephrine was nebulised alone or as concurrent medication.  In general, children less than two years, were included.

Authors' conclusion:

  • Nebulized epinephrine may be used to treat obstructive obstructive
    Increased resistance in the airways that reduces the amount of air inhaled in each breath and the oxygen that reaches the pulmonary arteries
    airway symptoms associated with moderate to severe croup croup
    Croup (or laryngotracheobronchitis) is a respiratory condition that is usually triggered by an acute viral infection of the upper airway. The infection leads to swelling inside the throat, which interferes with normal breathing and produces the classical symptoms of a "barking" cough, stridor, and hoarseness.
    .
  • The clinical effect of nebulized epinephrine is apparent at 30 minutes post-treatment.
  • There is no evidence to suggest that croup croup
    Croup (or laryngotracheobronchitis) is a respiratory condition that is usually triggered by an acute viral infection of the upper airway. The infection leads to swelling inside the throat, which interferes with normal breathing and produces the classical symptoms of a "barking" cough, stridor, and hoarseness.
    symptoms, on average, worsen after the treatment effect of nebulized epinephrine dissipates.


Bjornson et al. Cochrane Database Syst Rev. 2013 Oct 10;10:CD006619


For an optimal drug deposition in the upper airways tract, extra large particles are needed. The new PARI XLent can optimize the treatment with an average particle size of 7.3 µm and is thus especially suitable for the treatment of croup croup
Croup (or laryngotracheobronchitis) is a respiratory condition that is usually triggered by an acute viral infection of the upper airway. The infection leads to swelling inside the throat, which interferes with normal breathing and produces the classical symptoms of a "barking" cough, stridor, and hoarseness.
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The PARI XLent is the latest device of the well-proven PARI product family and is now available!