Multicentre study revealed significant gaps between evidence-based recommendations for using corticosteroids for croup and clinical practice.

AIM: Adherence to croup management recommendations has been poorly investigated. This study aimed to describe the treatment patterns in two paediatric emergency departments and analyse the adherence to recommendations. METHODS: We conducted a retrospective chart review of children diagnosed with croup in two Italian paediatric emergency departments in 2017. Data on clinical presentation, corticosteroid administration and home therapy were collected. Length of stay, hospitalisation and re-access rates were compared among different corticosteroid treatment groups. RESULTS: We enrolled 632 patients (61.1% males) with a mean age of 42.8 ± 55.1 months. Corticosteroids were administered to 403 (63.8%) children in the emergency departments. Dexamethasone was administered to 1 (0.4%) patient. Inhaled and oral corticosteroids were given to 342 (54.1%) and 226 (35.8%) patients, respectively. Home therapy was prescribed for 603 (95.4%) patients, either with inhaled (86.2%) and/or oral (43.8%) corticosteroids. The re-access rate was 2.8%. The actual pharmaceutical costs were an estimated 10 times higher than they would have been if the recommendations had been followed. CONCLUSION: A significant gap between the evidence and clinical practice for croup treatment was observed. Improving adherence to the recommendations could lead to clinical and economic benefits.

Air pollution is associated with incidence of viral croup among children living in Kraków area, Poland.

BACKGROUND: Air pollution is a severe problem in Poland, with Kraków area being among the regions with the worse air quality. Viral croup or pseudocroup is a common childhood disease that may manifest with severe upper respiratory tract obstruction. Our aim was to evaluate the associations between incidence and severity of viral croup symptoms among children living in Kraków area, Poland, and air pollution. METHODS: The retrospective cross-sectional study included Kraków area residents <18 years of age admitted to the Emergency Department of St. Louis Children Hospital in Kraków, Poland over 2-year period. Daily mean concentrations of air pollutants: particulate matter (PM10 and PM2.5), nitric oxides (NOx), carbon oxide (CO), sulfur dioxide, ozone, and benzene were retrieved from public database of measurements performed at three local stations. Numbers of cases of viral croup per week were correlated with weekly mean concentrations of air pollutants. Mean air temperature was treated as a cofactor. RESULTS: During the studied period, mean concentrations of PM10, PM2.5, and NOx exceeded the allowable levels (yearly means) specified by Polish law regulations. Significant positive correlations of moderate strength were observed between weekly mean concentrations of most air pollutants, especially PM10, PM2.5, CO and benzene, and numbers of cases of viral croup recorded per week, confirmed in the analysis restricted to non-holiday period and to winter months only. The correlations between NOx, CO, benzene and croup prevalence were independent of temperature in non-holiday period. CONCLUSIONS: Our results support adverse impact of air pollution on children's respiratory health.

Prenatal phthalate exposure was associated with croup in Swedish infants.

AIM: This study examined whether prenatal phthalate exposure was associated with lower or upper airway inflammation in infants. METHODS: From 2007 to 2010, we used liquid chromatography-tandem mass spectrometry, adjusted for creatinine, to analyse 14 phthalate metabolites and one phthalate replacement in the urine of 1062 Swedish mothers at a median of 10 weeks of pregnancy. This was used to determine any associations between prenatal phthalate exposure and croup, wheezing or otitis in their offspring until 12 months of age, using logistic regression, adjusted for potential confounders. RESULTS: There were significant associations between phthalate metabolites of butyl-benzyl phthalate (BBzP) and di-ethyl-hexyl phthalate (DEHP) concentrations in maternal prenatal urine and croup in 1062 infants during the first year of life, when adjusted for potential confounders. A dose-response relationship was found between prenatal phthalates exposure and maternal reported croup in the children, with a significant association in boys. There was no clear indication with regard to associations between prenatal phthalate exposure and wheezing or otitis media in the children during the first year of life. CONCLUSION: Our analysis suggests that exposure to BBzP and DEHP phthalates was associated with maternal reports of croup in infants up to 12 months of age.

Environmental pollution and parental smoking influence on the appearance of pseudocroup in children.

OBJECTIVE: The aim of the study was to assess the effect of environmental pollution and parental tobacco smoking on the occurrence of pseudocroup in children. MATERIAL AND METHODS: A questionnaire-study was performed in 345 children with pseudocroup admitted to the ENT Dept between 1997-2007. 116 children had smoking and 229 had non-smoking parents. Both groups were compared with respect to environmental pollution (urban, rural), parents' level of education, household crowding and breast feeding period. The prevalence of upper and lower respiratory tract infections and the presence of allergy were also anlaysed. The results were compared to those performed in the ENT Dept in 1977-1986. RESULTS: In the group of rural children, 21 were children with pseudocroup from smoking parents and 36 children of non-smoking parents. Among children living in the urban areas there were 95 from smoking parents and 193 from non-smoking parents. Both non-smoking parents presented a large group of people with a higher level of education, and in the smoking families both parents presented a lower level of education. Analysis of the breast feeding period revealed that it was the longest (up to 9 months) in non-smoking mothers--21% of the group, and only in 4.3% of smoking mothers.

[Relationship between pseudocroup and air pollutant burden of the inhaled air and weather]. / Zusammenhang zwischen Auftreten von Pseudokrupp und Schadstoff-belastung der Atemluft und Wetter.

An epidemiological study is presented to demonstrate, in addition to the viral aetiology, the influence of airpollution and various weather conditions to the incidence of croup. By means of a special statistic tool (baseline data curves) we could demonstrate that rapid changes in airpollutants (especially NO and NO2) are followed by increased occurrence of croup. In addition, the quotient NO2/NO seems to correlate directly to the O3 concentration. The noticeable influence of airpollution as well as changing climatic conditions demonstrate the multiform aetiology of croup.