Alternative Names: Viral croup; Laryngotracheobronchitis – acute; Spasmodic croup
Definition:
Croup is a respiratory condition that is usually triggered by an acute viral infection of the upper airway. The infection leads to swelling inside the throat, which interferes with normal breathing and produces the classical symptoms of a “barking” cough, stridor, and hoarseness. It may produce mild, moderate, or severe symptoms, which often worsen at night.
The barking cough of croup is the result of inflammation around the vocal cords (larynx) and windpipe (trachea). When the cough reflex forces air through this narrowed passage, the vocal cords vibrate with a barking noise. Because children have small airways to begin with, those younger than age 5 are most susceptible to having more-marked symptoms with croup.
Croup typically occurs between the ages of six months and six years, but the peak age is two and it’s less common after three. Children with asthma may get repeated episodes.
Croup usually isn’t serious. Most cases of croup can be treated at home. Sometimes, your child will need prescription medication.
Once due primarily to diphtheria, this cause is now primarily of historical significance in the Western world due to the success of vaccination.
Croup affects about 15% of children, and usually presents between the ages of 6 months and 5–6 years. It accounts for about 5% of hospital admissions in this population. In rare cases, it may occur in children as young as 3 months and as old as 15 years. Males are affected 50% more frequently than are females, and there is an increased prevalence in autumn (fall).
History:
The word croup comes from the Early Modern English verb croup, meaning “to cry hoarsely”; the name was first applied to the disease in Scotland and popularized in the 18th century. Diphtheritic croup has been known since the time of Homer’s Ancient Greece and it was not until 1826 that viral croup was differentiated from croup due to diphtheria by Bretonneau. Viral croup was thus called “faux-croup” by the French, as “croup” then referred to a disease caused by the diphtheria bacteria. Croup due to diphtheria has become nearly unknown due to the advent of effective immunization
Symptoms:
Croup is characterized by a “barking” cough, stridor, hoarseness, and difficult breathing which usually worsens at night. The “barking” cough is often described as resembling the call of a seal or sea lion.
As the cough gets more frequent, the child may have labored breathing or stridor (a harsh, crowing noise made during inspiration).The stridor is worsened by agitation or crying, and if it can be heard at rest, it may indicate critical narrowing of the airways. As croup worsens, stridor may decrease considerably.
Other symptoms include fever, coryza (symptoms typical of the common cold), and chest wall indrawing. Drooling or a very sick appearance indicate other medical conditions
Rarely, croup can last for weeks. Croup that lasts longer than a week or recurs frequently should be discussed with your doctor to determine the cause.
Causes:
Viral croup is the most common. Other possible causes include bacteria, allergies, and inhaled irritants. Acid reflux from the stomach can trigger croup.
Croup is usually (75% of the time) caused by parainfluenza viruses, but RSV, measles, adenovirus, and influenza can all cause croup.
Before the era of immunizations and antibiotics, croup was a dreaded and deadly disease, usually caused by the diphtheria bacteria. Today, most cases of croup are mild. Nevertheless, it can still be dangerous.
Croup tends to appear in children between 3 months and 5 years old, but it can happen at any age. Some children are prone to croup and may get it several times.
In the northern hemisphere, it is most common between October and March, but can occur at any time of the year.
In severe cases of croup, there may also be a bacterial superinfection of the upper airway. This condition is called bacterial tracheitis and requires hospitalization and intravenous antibiotics. If the epiglottis becomes infected, the entire windpipe can swell shut, a potentially fatal condition called epiglottitis.
Diagnosis:
Croup is a clinical diagnosis. The first step is to exclude other obstructive conditions of the upper airway, especially epiglottitis, an airway foreign body, subglottic stenosis, angioedema, retropharyngeal abscess, and bacterial tracheitis.
A frontal X-ray of the neck is not routinely performed, but if it is done, it may show a characteristic narrowing of the trachea, called the steeple sign. The steeple sign is suggestive of the diagnosis, but is absent in half of cases.
Other investigations (such as blood tests and viral culture) are discouraged as they may cause unnecessary agitation and thus worsen the stress on the compromised airway. While viral cultures, obtained via nasopharyngeal aspiration, can be used to confirm the exact cause, these are usually restricted to research settings. Bacterial infection should be considered if a person does not improve with standard treatment, at which point further investigations may be indicated
Severity:
The most commonly used system for classifying the severity of croup is the Westley score. It is primarily used for research purposes rather than in clinical practice. It is the sum of points assigned for five factors: level of consciousness, cyanosis, stridor, air entry, and retractions.The points given for each factor is listed in the table to the right, and the final score ranges from 0 to 17.
*A total score of ? 2 indicates mild croup. The characteristic barking cough and hoarseness may be present, but there is no stridor at rest.
*A total score of 3–5 is classified as moderate croup. It presents with easily heard stridor, but with few other signs.
*A total score of 6–11 is severe croup. It also presents with obvious stridor, but also features marked chest wall indrawing.
*A total score of ? 12 indicates impending respiratory failure. The barking cough and stridor may no longer be prominent at this stage.
85% of children presenting to the emergency department have mild disease; severe croup is rare (<1%).
Treatment :-
Most cases of croup can be safely managed at home, but call your health care provider for guidance, even in the middle of the night.
Cool or moist air might bring relief. You might first try bringing the child into a steamy bathroom or outside into the cool night air. If you have a cool air vaporizer, set it up in the child’s bedroom and use it for the next few nights.
Acetaminophen can make the child more comfortable and lower a fever, lessening his or her breathing needs. Avoid cough medicines unless you discuss them with your doctor first.
You may want your child to be seen. Steroid medicines can be very effective at promptly relieving the symptoms of croup. Medicated aerosol treatments, if necessary, are also powerful.
Serious illness requires hospitalization. Increasing or persistent breathing difficulty, fatigue, bluish coloration of the skin, or dehydration indicates the need for medical attention or hospitalization.
Medications are used to help reduce upper airway swelling. This may include aerosolized racemic epinephrine, corticosteroids taken by mouth, such as dexamethasone and prednisone, and inhaled or injected forms of other corticosteroids. Oxygen and humidity may be provided in an oxygen tent placed over a crib. A bacterial infection requires antibiotic therapy.
Increasing obstruction of the airway requires intubation (placing a tube through the nose or mouth through the larynx into the main air passage to the lungs). Intravenous fluids are given for dehydration. In some cases, corticosteroids are prescribed.
Alternative Treatments :-
Since most croup cases are mild in severity, over the counter treatments are often used. These treatments include ointments such as Vick’s or other menthol creams. These often are used to open up the airways. Other over the counter treatments include humidifiers to keep the humidity up in a room and lessen the chances of the airways becoming further inflamed or irritated.
Other methods of breaking croup attacks include hot shower exposure and cold air exposure. In the hot shower method, the shower is used as a sauna, in that the shower is running but people sit outside of it, taking in the warm, humid air. This method can be very effective when used in ten minute increments. Cuddling or reading to the child can limit the stress that is on the child during such a treatment. Cold or cool air exposure is another very effective alternative treatment. This method of treatment relies on the idea that the inflamed tissues will cool and shrink when exposed to cool air. Since most croup cases occur during the fall or winter seasons, this is often achieved simply by going outside or driving with the windows rolled down.
Lifestyle and home remedies:
Croup often runs its course within three to seven days. In the meantime, keep your child comfortable with a few simple measures.
*Stay calm. Comfort or distract your child — cuddle, read a book or play a quiet game. Crying makes breathing more difficult.
*Moisten the air. Use a cool-air humidifier in your child’s bedroom or have your child breathe the warm, moist air in a steamy bathroom. Although researchers have questioned the benefits of humidity as part of emergency treatment for croup, moist air seems to help children breathe easier — especially when croup is mild.
*Get cool. Sometimes breathing fresh, cool air helps. If it’s cool outdoors, wrap your child in a blanket and walk outside for a few minutes.
*Hold your child in an upright position. Sitting upright can make breathing easier. Hold your child on your lap, or place your child in a favorite chair or infant seat.
*Offer fluids. For babies, water, breast milk or formula is fine. For older children, soup or frozen fruit pops may be soothing.
*Encourage resting. Sleep can help your child fight the infection.
*Try an over-the-counter pain reliever. If your child has a fever, acetaminophen (Tylenol, others) may help. Cough syrup, which doesn’t affect the larynx or trachea, isn’t likely to relieve your child’s cough. Over-the-counter cold preparations are not recommended for children younger than age 5.
Your child’s cough may improve during the day, but don’t be surprised if it returns at night. You may want to sleep near your child or even in the same room so that you can take quick action if your child’s symptoms become severe.
Prognosis:
Viral croup is usually a self-limited disease, but can very rarely result in death from respiratory failure and/or cardiac arrest. Symptoms usually improve within two days, but may last for up to seven days. Other uncommon complications include bacterial tracheitis, pneumonia, and pulmonary edema
Prevention:
To prevent croup, take the same steps you use to prevent colds and flu. Frequent hand washing is most important. Also keep your child away from anyone who’s sick, and encourage your child to cough or sneeze into his or her elbow.
To stave off more-serious infections, keep your child’s immunizations current. The diphtheria, Haemophilus influenzae type b (Hib) and measles vaccines offer protection from some of the rarest — but most dangerous — forms of upper airway infection.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:
http://www.bbc.co.uk/health/physical_health/conditions/croup2.shtml
http://www.mayoclinic.com/health/croup/DS00312
http://en.wikipedia.org/wiki/Croup
http://www.nlm.nih.gov/medlineplus/ency/article/003215.htm
http://modernmedicalguide.com/croup-acute-spasmodic-laryngitis/
http://savingmommymoney.com/croup-symptoms-and-cure
http://www.methodsofhealing.com/Healing_Conditions/croup/
http://www.sciencephoto.com/images/download_lo_res.html?id=770500647
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