Scientific article
Open access

Outdoor cold air versus room temperature exposure for croup symptoms : a randomized controlled trial

Published inPediatrics, vol. 152, no. 3, e2023061365
  • Statement of Correction: Outdoor Cold Air Versus Room Temperature Exposure for Croup Symptoms: A Randomized Controlled Trial. Pediatrics. 2024 Mar 1;153(3):e2023065508. doi: 10.1542/peds.2023-065508. Erratum for: Pediatrics. 2023 Sep 1;152(3): PMID: 38415304.
  • DOI : 10.1542/peds.2023-065508
  • PMID : 38415304
Publication date2023-09-01

Objectives: Croup is the most common cause of acute upper airway obstruction in children. The benefits of treating croup with steroids are well established, with an onset of effect 30 minutes after administration. We investigated whether a 30-minute exposure to outdoor cold air might improve mild to moderate croup symptoms before the onset of action of steroids.

Methods: This open-label, single-center, randomized controlled trial, enrolled children aged 3 months to 10 years with croup and a Westley Croup Score (WCS) ≥2 attending a tertiary pediatric emergency department. Participants were randomized (1:1) to either a 30-minute exposure to outdoor cold (<10°C) atmospheric air or to indoor ambient room air immediately after triage and administration of a single-dose oral dexamethasone. The primary endpoint was a decrease in WCS ≥2 points from baseline at 30 minutes. Analyses were intention to treat.

Results: A total of 118 participants were randomly assigned to be exposed to outdoor cold air (n = 59) or indoor room temperature (n = 59). Twenty-nine of 59 children (49.2%) in the outdoor group and 14 of 59 (23.7%) in the indoor group showed a decrease in WCS ≥2 points from baseline at 30 minutes after triage (risk difference 25.4% [95% confidence interval 7.0-43.9], P = .007). Patients with moderate croup benefited the most from the intervention at 30 minutes (risk difference 46.1% [20.6-71.5], P < .001).

Conclusions: A 30-minute exposure to outdoor cold air (<10°C), as an adjunct to oral dexamethasone, is beneficial for reducing the intensity of clinical symptoms in children with croup, especially when moderate.

  • Child
  • Humans
  • Infant
  • Croup / drug therapy
  • Croup / etiology
  • Temperature
  • Dexamethasone / therapeutic use
  • Glucocorticoids / therapeutic use
  • Emergency Service, Hospital
Citation (ISO format)
SIEBERT, Johan et al. Outdoor cold air versus room temperature exposure for croup symptoms : a randomized controlled trial. In: Pediatrics, 2023, vol. 152, n° 3, p. e2023061365. doi: 10.1542/peds.2023-061365
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ISSN of the journal0031-4005

Technical informations

Creation09/21/2023 1:56:32 PM
First validation04/17/2024 8:19:35 AM
Update time04/17/2024 8:19:35 AM
Status update04/17/2024 8:19:35 AM
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