Treatment of Laryngotracheobronchitis

To the Editor .—As the authors of one of the "several uncontrolled studies" mentioned, we would like to comment on the article "Treatment of Laryngotracheobronchitis (Croup)" by Taussig et al in the July 1975 issue of theJournal(129:790-793, 1975). This study demonstrates clearly two points: first, the dramatic, beneficial effect of intermittent positive-pressure breathing (IPPB) in the treatment of croup; and second, the difficulty of performing a meaningful, controlled study of this form of treatment. These authors rated their patients on a scale of severity ranging from 1 to 14. A child who was rated 10 or higher must have been in serious trouble indeed. Review of Table 4 (page 792) shows patients with ratings as high as 13 (case 1), yet no decision to perform a tracheotomy was made. On the other hand, patient 5 was never rated above 9, and in fact had ratings considerably less, but