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About Sickkids
About SickKids

Suzanne Schuh, MD, FRCP(C), ABPEM

The Hospital for Sick Children
Staff Physician
Paediatric Emergency Medicine

Research Institute
Senior Associate Scientist
Child Health Evaluative Sciences

University of Toronto

Phone: 416-813-6239
Fax: 416-813-5043
Email: suzanne.schuh@sickkids.ca

Academic Background

University of Toronto

Hospital for Sick Children


Research Interests

  • Paediatric Emergency
  • Bronchiolitis
  • Asthma
  • Croup
  • Clinical Trials

Management of children with acute respiratory diseases such as croup, asthma and bronchiolitis.

Research Activities

2002 Efficacy of oral dexamethasone in outpatients with acute bronchiolitis.

(J Pediatr, 2002)
This study was the first to demonstrate that oral corticosteroids produce significant clinical and hospitalization benefit within 4 hours in moderate to severe bronchiolitis. As a result, many babies will benefit from this intervention, with potential significant decrease in utilization of in-patient resources.

1990 Efficacy of nebulized albuterol in acute bronchiolitis.
(J Pediatr, 1990)
This study was the first to demonstrate clinical efficacy of nebulized beta 2 agonists in babies with acute bronchiolitis. A trial of beta 2 agonists had subsequently become part of routine management of this disease in the Emergency Department. Although a source of ongoing controversy, a subsequent meta-analysis showed that 54 per cent of babies with bronchiolitis respond to beta 2 agonist therapy and that a trial of beta 2 agonists is warranted.

2000 Efficacy of inhaled fluticasone vs. oral prednisolone in severe childhood asthma.

(NEJM, 2000)
Although topically delivered corticosteroids with minimal systemic absorption appear ideal for asthma therapy. This Emergency Department study showed that children with severe acute asthma given oral prednisolone had 3 times lower hospitalization rates within four hours than those given inhaled fluticasone. Children with severe asthma need a systemic route of steroid delivery for successful stabilization.

1999 Predictors of hospitalization in children with acute asthma.
(J Pediatr,2001)
This study demonstrated that children with three or more of the following five predictors: past history of ICU admission, baseline SaO2 6/9 or SaO2 92 per cent probability of needing hospital admission. Contrary to previous studies, this trial used the length of bronchodilator therapy as the primary outcome, thus maximizing the identification of the appropriate need for hospitalization.

1999 High versus low dose albuterol therapy via Metered Dose Inhaler (MDI) and spacer versus nebulizer in children with mild acute asthma. (J Pediatr, 1999)
Unlike children with very serious acute asthma, children with mild acute asthma derive similar clinical benefit from treatment with standard low dose of two puffs of albuterol via MDI as compared to a higher MDI dose or compared to standard nebulizer doses, with significantly fewer side effects.

1993 Nebulizer versus metered dose inhaler in children with moderate to severe acute asthma.
(J Pediatr, 1993)
This study of school aged children with baseline FEV1 between 20 to 69 per cent predicted value demonstrated that 600-1000 mcg of salbutamol is required to achieve comparable outcomes to nebulizer therapy during the stabilization period in the Emergency Department.

1995 Efficacy of addition of nebulized ipratropium to nebulized albuterol therapy in children with severe acute asthma.
(J Pediatr, 1995)
This study concluded that treatment of children with baseline FEV1 under 50 per cent predicted with three consecutive doses of nebulized ipratropium results in greater clinical improvement in two hours than children given only one dose or no ipratropium, with reduction in hospitalizations in children with baseline FEV1 under 30 per cent predicted value.

1998 A comparison of nebulized budesonide, intramuscular dexamethasone and placebo for moderately severe croup.
(NEJM, 1998)
This trial showed that although both nebulized budesonide and intramuscular dexamethasone decrease hospitalization rate compared to placebo; a single dose of systemic dexamethasone results in significantly greater clinical improvement within five hours of therapy than nebulized budesonide. Hence, systemic corticosteroids have become standard Emergency Department management in children with severe croup.


2000 & 2001 - Society for Academic Emergency Medicine Award for Best Clinical Science Paper


Schuh S, Coates AL, Binnie R, Allin T, Goia C, Corey M, Dick PT: Efficacy of oral dexamethasone in outpatients with acute bronchiolitis. Journal of Pediatrics 2002: 140: pp 27-32. abstract

Boutis K, Komar L, Jaramillo D, Babyn P, Alman B, Snyder B, Mandl KD, Schuh S. The sensitivity of a clinical exam to predict the need for radiographs in children with ankle injuries. Lancet 2001: 358: pp 2118-21.

Keogh KA, Parkin PC, Macarthur C, Stephens D, Arseneault R, Tennis O, Bacal L, Schuh S. Predictors of hospitalization in children with acute asthma. The Journal of Pediatrics: 139: pp 273-7, 2001.

Schuh S, Reisman J, Alshehri M, Dupuis A, Corey M, Arseneault R, Alothman G, Tennis O, Canny G: A comparison of inhaled fluticasone propionate and oral prednisone of children with severe acute asthma. New England Journal of Medicine 2000: 343 (10): pp 689-694. abstract

Canny GJ, Schuh S: Management of Severe Acute Asthma in Children. In: Evidence Based Asthma Management (Fitzgerald M, O'Byrne P, Boulet LP, Ernst P, eds). BC Decker, 2000.

Schuh S: Lower Airway Obstruction. In: Handbook of Pediatric Emergencies (Baldwin G, Schuh S, eds). Lippincott, Williams and Wilkins, Philadelphia, PA 2000.

Schuh S, Johnson D, Callahan S, Stephens D, Winders P, Canny G: High versus low dose albuterol therapy via metered dose inhaler versus nebulizer in children with mild acute asthma. Journal of Pediatrics 1999: 135: pp 22-27. abstract

Schuh S. Under what circumstances would you use a corticosteroid to treat croup? What regimen would you recommend? The Journal of Respiratory Diseases, 1999.