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To the Editor: In their study comparing controlled delivery of high humidity, low humidity, and mist therapy for croup in emergency departments, Dr Scolnik and colleagues¹ demonstrated that mist therapy does not lead to an improvement in croup scores. Their study also suggests that a reexamination of the use of aerosolized epinephrine in mild croup is warranted.

Aerosolized epinephrine use for croup in the emergency department has generally been reserved for moderate to severe disease for 2 reasons. First, mild disease has been believed to respond to cool mist so that aerosolized epinephrine is not necessary.² Second, all patients who get aerosolized epinephrine are believed to require several hours of observation in the emergency department prior to discharge.³

Scolnik et al cast considerable doubt on the first reason. The second, however, is dubious as well. The effect of aerosolized epinephrine is temporary, and there is some possibility of the patient . . . [Full Text of this Article]

Richard Gabor, MD
mail@rickygabor.com
Department of Emergency Medicine
Baystate Medical Center
Springfield, Mass

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