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Lack of efficacy of humidification in the treatment of croup: Why do physicians persist in using an unproven modality?

Published online by Cambridge University Press:  21 May 2015

Elana Lavine
Affiliation:
Faculty of Medicine, University of Toronto
Dennis Scolnik*
Affiliation:
Division of Emergency Services, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ont
*
Emergency Services, The Hospital for Sick Children, 555 University Ave., Toronto ON M5G 1X8; 416 813-4915, fax 416 813-5043, [email protected]

Abstract

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Background:

Humidification is a time-honoured therapy for childhood croup (acute laryngotracheobronchitis). Despite a paucity of evidence supporting its use, many physicians, nurses and parents still apply this treatment. Our objective was to summarize available evidence and assess the rationale for the ongoing use of humidity to treat childhood croup.

Methods:

Searches of both MEDLINE and the Cochrane Database were conducted for English-language original or review literature on the treatment of croup with humidity, for the years 1966-1999.

Results:

Only 2 published studies have attempted to evaluate humidification therapy for croup, and none has been published since 1984. There is no published evidence to support the commonly held empirical view that humidity helps alleviate the symptoms of childhood croup, and no understanding of which factors of moisture or temperature affect patient outcomes. Risks may include scalding and unnecessary discomfort.

Interpretation:

There is no strong evidence supporting the use of humidity in the treatment of croup. Although such treatment is still widely used, it is not without risk, and further trials are required to address its efficacy.

Type
Pediatrics • Pédiatrie
Copyright
Copyright © Canadian Association of Emergency Physicians 2001

References

1.Rosenkrans, JA.Viral croup: current diagnosis and treatment. Mayo Clin Proc 1998;73:11027.CrossRefGoogle Scholar
2.Kaditis, AG, Wald, ER.Viral croup: current diagnosis and treatment. Pediatr Infect Dis J 1998;17:82734.Google Scholar
3.Folland, DS.Treatment of croup: sending home an improved child and relieved parents. Postgrad Med 1997;101(3):2718.Google Scholar
4.Henry, R.Moist air in the treatment of laryngotracheitis. Arch Dis Child 1983;58(8):577.Google Scholar
5.Asher, MI.Infections of the upper respiratory tract. In: Taussig, LM, Landau, LI, editors. Pediatric respiratory medicine. St. Louis: Mosby; 1999.Google Scholar
6.Dulfano, MJ, Adler, K, Wooten, K.Physical properties of sputum: effects of 100 per cent humidity and water mist. Am Rev Respir Dis 1973;107:1302.Google ScholarPubMed
7.Szilagyi, PG.Humidifiers and other symptomatic therapy for children with respiratory tract infections. Pediatr Infect Dis J 1991;10:4789.Google ScholarPubMed
8.Sasaki, CT, Suzuki, M.The respiratory mechanism of aerosol inhalation in the treatment of partial airway obstruction. Pediatrics 1977;59:68994.CrossRefGoogle ScholarPubMed
9.Ophir, D, Elad, Y.Effects of steam inhalation on nasal patency and nasal symptoms in patients with the common cold. Am J Otolaryngol 1987;8:14953.Google Scholar
10.Greally, P, Cheng, K, Tanner, MS, Field, DJ.Children with croup presenting with scalds. BMJ 1990;301(6743):113.CrossRefGoogle ScholarPubMed
11.Tamer, MA, Modell, JH, Rieffel, CN.Hyponatremia secondary to ultrasonic aerosol therapy in the newborn infant. J Pediatr 1970;77:10514.Google Scholar
12.Covelli, HD, Kleeman, J, Martin, JE, Landau, WL, Hughes, RL.Bacterial emission from both vapor and aerosol humidifiers. Am Rev Respir Dis 1973;108:698701.Google ScholarPubMed
13.Solomon, WR.Fungus aerosols arising from cold-mist vaporizers. J Allergy Clin Immunol 1974;54:2228.Google Scholar
14.O’Callaghan, C, Barry, PW.The science of nebulised drug delivery. Thorax 1997;52(Suppl 2):S3144.Google Scholar
15.Rudolf, G, Kobrich, R, Stahlhofen, W.Modelling and algebraic formulation of regional aerosol deposition in man. J Aerosol Sci 1990;21(Suppl 1):S306406.Google Scholar
16.Ho, SL, Coates, AL.The effect of dead volume on the efficiency and the cost to deliver medications in cystic fibrosis with four disposable nebulizers. Can Respir J 1999;6:25360.CrossRefGoogle ScholarPubMed
17.Wolfsdorf, J, Swift, DL.An animal model simulating acute infective upper airway obstruction of childhood and its use in the investigation of croup therapy. Pediatr Res 1978;12:10625.Google Scholar
18.Bourchier, D, Dawson, KP, Fergusson, DM.Humidification in viral croup: a controlled trial. Aust Pediatr J 1984;20:28991.Google ScholarPubMed
19.Lenney, W, Milner, AD.Treatment of acute viral croup. Arch Dis Child 1978;53:7046.Google Scholar
20.Kristjansson, S, Berg-Kelly, K, Winso, E.Inhalation of racemic adrenaline in the treatment of mild and moderately severe croup: clinical symptom score and oxygen saturation measurements for evaluation of treatment effects. Acta Paediatr 1994;83(11):115660.CrossRefGoogle ScholarPubMed
21.Gardner, HG, Powell, KR, Roden, VJ, Cherry, JD.The evaluation of racemic epinephrine in the treatment of infectious croup. Pediatrics 1973;52:6871.CrossRefGoogle ScholarPubMed
22.Cantor, RM.Emergencies of the upper airways. In: Strange, GR, Ahrens, WR, Schafermeyer, RW, Tepper, WC, editors. Pediatric emergency medicine: a comprehensive study guide. American College of Emergency Physicians. New York: McGraw-Hill Ryerson; 1999.Google Scholar
23.Solomon, M.Respirology. In: Dipchand, AI, editor. Hospital for Sick Children handbook of pediatrics, 9th ed. Toronto: Mosby; 1997.Google Scholar