Nebulised Pulmicort (Budesonide) 2.0mg is extremely effective (but not available in the USA still?). The onset is as rapid as racemic epi and it has a good duration of action. I think our admission rates for croup have halved since this has become standard treatment here. Some docs like to give (in addition) an oral dose of Dexamethasone (about 0.3mg/dose) for good measure - I do this in more severe cases at it has been shown to work as well as i.m.. (When my son had croup the Dex turned him into the Energizer bunny for 12 hours!) Steve Wainer MD FRCPC Calgary