Sir.—Koren et al1 reported the efficacy of dexamethasone sodium phosphate in treating laryngotracheitis (LT) and spasmodic croup (SC) in children. They wrote that "corticosteroid therapy significantly accelerated the improvement of SC and failed to influence the course of LT." These results contradict the findings of Massicotte and Tétreault2; however, many differences must be noted between these studies.
First, the definitions of SC and LT were quite similar in both studies, but the sample was quite different. Koren et al1 included all mild cases of croup. Massicotte and Tétreault2 included only severe cases that corresponded to 11% of patients who were hospitalized for croup or laryngitis at Sainte-Justine Hospital, Montreal; all these patients had inspiratory stridor, dyspnea, barking cough, and accelerated respiratory frequency (respirations, >25/min).
Second, the treatment differed. Koren et al1 gave some chloral hydrate in each instance, while Massicotte and Tétreault2 did