Is cool mist administration an effective treatment for croup?

Updated: Oct 09, 2019
  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD  more...
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Historically, cool mist administration was the mainstay of treatment for croup. Hospitals had "croup rooms" filled with cool mist. Theoretically, mist moistens airway secretions, decreases their viscosity, and soothes the inflamed mucosa. Animal data show that microaerosol inhalation activates mechanoreceptors that produce a reflex slowing of respiratory flow rate and leads to improved airflow.

However, despite its continued widespread use, further evidence does not strongly support the clinical efficacy of cool mist or humidification therapy. Randomized studies of children with moderate-to-severe croup revealed no difference in outcome between those who received cool mist and those who did not. [24] However, cool mist tents are still used in the inpatient hospital setting. Besides having the potential to disperse fungus and molds if not properly cleaned, the tents separate child from parent by creating a “plastic barrier;" thus causing anxiety and agitation with potential to worsen the child’s symptoms and hinder required ongoing clinical assessment. [25, 26] In the home, cool mist humidifiers can be used; however vaporizers (heated humidification) producing hot steam to moisten the air should not be used to avoid the risk of scalding or burns.

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