AIM: The purpose of this study was to determine whether local anti-inflammatory therapy with inhaled beclomethasone dipropionate is effective in the outpatient management of acute viral croup.METHODS: Children six months to five years of age, presenting to the Emergency Department (ED) with a croup score of at least 2 participated in the study. All children were assigned in a randomised double-blind fashion to receive either nebulized L-epinephrine (LE), a single intramuscular injection of dexamethasone (D) 0.6 mg/kg, or inhaled beclomethasone dipropionate (BD) 200 mg, via aerochamber. Croup score (CS), heart rate (HR), blood pressure, respiratory rate (RR) and oxygen saturation were recorded at study entry and at 15, 30, 60, 90 and 120 minutes after treatment.RESULTS: Sixty-four patients were enrolled into the study. Significant improvement of the croup score was noticed at the end of observation time in all groups. The LE group showed significant improvements of CS, HR and RR in comparison to the other two groups. Inhaled BD was as effective as intramuscular D in the treatment of mild to moderate croup in the ED.CONCLUSION: The use of inhaled beclomethasone in the outpatient management of croup was associated with a significant reduction in the severity of illness within 24 h after treatment.