Epinephrine MDI for Pediatric Croup. Academic Emergency Medicine

Croup is a common childhood disease of young children caused by viral infections that trigger varying degrees of upper airway obstruction. While croup of all severity is effectively treated with systemic corticosteroids,1 nebulized epinephrine provides rapid and safe reduction in respiratory distress that lasts for 1–2 h.2 The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) raised concerns about nebulization as an aerosol-generating medical procedure (AGMP), prompting a search for alternative delivery methods to provide effective epinephrine therapy in children with croup to minimize SARS-CoV-
2 transmission. Primatene Mist is an epinephrine metered-dose inhaler (MDI) manufactured and available over the counter in the United States.3 At the request of Canadian pediatric emergency departments (PEDs), Health Canada provided a letter of no objection to direct import of the Primatene MDI to these PEDs. Given the absence of evidence regarding appropriate dosing, nine PEDs established a national quality assurance (QA) network and seven contributed data to monitor the safety and efficacy of using an epinephrine MDI for the off-label treatment of croup.