Croup (laryngotracheobronchitis) is a common respiratory disease of childhood with a peak incidence in the second year. Symptoms are often distressing to both child and parent, and severe croup can threaten life. About 1 in 10 children with croup is admitted to hospital and of these 1 in 20 needs active intervention to maintain the airway or treat respiratory failure.1 In the USA nebulised adrenaline has become standard treatment for children with moderate or severe croup but is less widely used in the UK and is unlicensed. More recently nebulised budesonide has been promoted as first line treatment for mild to severe croup. In this article we review these two approaches.
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