Croup Cough: Symptoms, Cause, Treatment

What is croup? Croup is a respiratory condition that results in swelling of airways, usually due to a viral infection, and a harsh barking croup cough. It is most common among children 1 to 5 years old and rarely happens in adults and teenagers since they have larger airways.

The infection accompanied by croup is usually contagious. Hand-washing, strictly nose breathing (to prevent infections entering through the mouth), and other hygienic precautions are crucial for health of the household members. For mouth breathing effects, visit Mouth Breathing Problems.

Cause of croup cough

In most cases, croup is caused by alveolar hyperventilation (breathing more air than the medical norm) that leads to hypocapnia (deficiency of CO2 or carbon dioxide). Hypocapnia causes constriction of airways, promotes chronic inflammation, and irritable state of nerve cells leading to chronic expression of the urge-to-cough reflex. Other effects of alveolar hypocapnia are reduced body oxygen content, production of free radicals in hypoxic cells, and the suppressed immune system due to tissue hypoxia. The dysfunctional immune system cannot prevent infections and, superficially, infections look like the cause of croup, but in reality chronic hyperventilation is the cause of croup cough.

Treatment of croup cough

Most cases of croup cough do not require ER (Emergency Room) treatment. However, if your child’s breathing gets even heavier, severe hyperventilation will cause: skin retractions (observe the skin between the ribs pulls in with each inhalation), a fatigued and very sick appearance, difficulty swallowing, drooling, stridor (squeaking sounds when inhaling), a color around the mouth, and symptoms of dehydration. Pay attention to all these signs in kids. They indicate that the situation gets more dangerous.

Home treatment

While leading health care providers continue to claim that use of humidified air is useful in management of croup cough, there is no medical evidence to support humidified air inhalation (Moore & Little, 2007; Wright et al, 2005; Lebecque, 1999). However, some parents and doctors still report that they get benefits from breathing steam from a hot bath (with or without essential oils) during croup attacks.

Clinical experience of medical doctors practicing breathing retraining have found that it is possible to reduce duration and severity of cough and infections. (Normally, this viral infections lasts for 3-5 days.). Step No. 1 is to teach a child, if possible, how to cough only through the nose to prevent CO2 losses and boost the immune system. Next, this simple breathing exercise how to treat croup cough in adults will help children too. The exercise should be practiced by adults and then taught to children. It also helps kids to fall asleep faster.

Reference Web Pages: Breathing norms, Medical Graphs and Tables about Breathing Rates (Minute Ventilation) and Body Oxygen in Healthy, Normal and Sick People
Breathing norms Parameters, graph, and description of the normal breathing pattern
6 breathing myths 6 myths about breathing and body oxygenation (prevalence: over 90%)
Hyperventilation Definitions of hyperventilation: their advantages and weak points
Hyperventilation Syndrome in the Sick. Table 1. Western scientific evidence about prevalence of CHV (chronic hyperventilation) in patients with various chronic conditions (34 medical studies)
Normal Minute Ventilation in Healthy Subjects: Easy and Light Breathing (14 Studies)
Hyperventilation Prevalence Present in Over 90% of Normal People (24 medical publications)
HV and hypoxia How and why deep breathing reduces oxygenation of cells and tissues of all vital organs
Body oxygen test How to measure your own breathing and body oxygenation (a simple DIY test)
Body oxygen in healthy Table 4. CP (body oxygen level) in healthy people (27 medical studies)
Body oxygen in sick Table 5. CP (body oxygen level) in sick people (14 medical studies)
Buteyko Table of Health Zones with clinical description of most common zones
Morning HV Morning hyperventilation effect or how and why critically ill people are most likely to die during early morning hours

References: CO2 Effects Web Pages
Vasodilation: CO2 expands arteries and arterioles facilitating perfusion (or blood supply) to all vital organs
The Bohr effect How and why oxygen is released by red blood cells in tissues
Cell Oxygen Levels and oxygen transport are controlled by alveolar CO2 and breathing
Oxygen Transport depends on breathing and these two effects (Vasoconstriction-Vasodilation and the Bohr effect) are parts of two diagrams that summarize influences of hypocapnia (low CO2 content in the blood and cells) on circulation and O2 delivery
Free Radical Generation takes place due to anaerobic cell respiration caused by cell hypoxia. Hence, antioxidant defenses of the human body are also regulated by CO2 and breathing
Inflammatory Response is controlled by breathing since hypoxia leads to or intensifies chronic inflammation through over-expression of the hypoxia-inducible factor 1, while normal breathing reduces these processes
Nerve stabilization takes place due to calmative or sedative effects of carbon dioxide in neurons or nerve cells
Muscle relaxation or relaxation of muscle cells is normal at high CO2, while hypocapnia causes muscular tension, poor posture and, sometimes, aggression and violence
Brochodilation - dilation of airways (bronchi and bronchioles) by carbon dioxide, and their constriction due to hypocapnia
Blood pH regulation and regulation of other bodily fluids
CO2: Lung Damage Healer: Elevated carbon dioxide prevents injury and promotes healing of lung tissues
CO2: Skin and Tissue Healer
Synthesis of Glutamine in the Brain, CO2 fixation, and other chemical reactions
CO2 myth "CO2 is a toxic waste gas" myth
Breathing control How is our breathing regulated? Why hypocapnia makes breathing uneven and erratic

References

Moore M, Little P, Humidified air inhalation for treating croup: a systematic review and meta-analysis, Fam Pract. 2007 Sep;24(4):295-301. Epub 2007 Jun 29.
BACKGROUND: Croup (laryngotracheobronchitis) is a common cause of upper airway obstruction in children. Treatment with humidified air was previously widely used and is still commonly recommended as home treatment.
OBJECTIVE: To assess the efficacy of humidified air in the treatment of croup.
DESIGN: Systematic review and meta-analysis.
DATA SOURCES: We searched the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE.
REVIEW METHODS: We included randomized controlled trials with or without blinding. All studies treating children with a clinical diagnosis of croup with warm or cool humidified air delivered by steam or humidified tent whether inpatients, attendees at the Emergency Department or in the community were eligible.
MAIN RESULTS: Three studies in emergency settings provided data on 135 patients with moderate croup for the main outcome (croup score). The combined results from 20 to 60 minutes in the three studies marginally favored the treatment group with a weighted standardized mean difference of -0.14 (95% confidence interval = -0.75 to 0.47). No outcomes were significantly different between the groups.
CONCLUSIONS: The croup score of children managed in an emergency setting with mild to moderate croup probably does not improve greatly with inhalation of humidified air. There is insufficient evidence to exclude either a small beneficial or a harmful effect.

Wright RB, Rowe BH, Arent RJ, Klassen TP, Current pharmacological options in the treatment of croup, Expert Opin Pharmacother. 2005 Feb;6(2):255-61.
Department of Pediatrics, Pediatric Emergency Medicine, 2C3, 8440-112 Street, Edmonton, Alberta, Canada. BWright@cha.ab.ca
Croup is one of the most common respiratory illnesses seen in the acute pediatric setting. It can be a cause of acute stridor and/or respiratory distress in young children. Research has shown that therapy aimed at reducing symptoms and inflammation can reduce complications such as the need for intubation, hospitalization and improve quality of life for parents and children. Corticosteroids are the primary treatment option that will accomplish both goals and can be used in out-patient and in-patient settings. Corticosteroids may be given orally, parenterally or in wet nebulised form; however, oral administration is the preferred route. Wet nebulised adrenaline (racaemic or l-adrenaline) is also an effective treatment for more severe cases of croup. Recent studies have shown that mist/humidified air provides no additional symptom improvement, nor does it alter the overall cause of the disease process. Currently, there is insufficient randomised controlled trial evidence to support the role of heliox in the short-term treatment of croup.

Lebecque P, Childhood croup [Article in French], Arch Pediatr. 1999 Jul;6(7):768-74.
Clinique Saint-Luc, université de Louvain, Bruxelles, Belgique.
Hoarseness, whooping cough and stridor are elements of a syndrome of upper airway obstruction. In childhood, acute laryngotracheobronchitis is by far the commonest cause of this syndrome. Yet, the differential diagnosis includes a number of rare and severe entities. In many cases, the traditional distinction between viral and spasmodic types is not possible. The value of humidifying therapy has not been established. In severe cases, nebulized adrenaline is of benefit but should be reserved for hospital. The effect lasts only two hours and at times a rebound effect is observed. It is now realized that some patients treated with adrenaline can safely be discharged after a two to three hours observation. There is a large body of evidence that all children arriving at the emergency department with croup should receive steroids without delay. This policy results in a much better outcome, with important reduction in hospitalizations, intensive care unit admissions and incubations. Oral dexamethasone is the drug of choice: it is as effective, easier to administer and cheaper than nebulised budesonide. In most studies, dexamethasone has been used at a dose of 0.6 mg/kg but there is some evidence that 0.15 mg/kg may be just as effective.

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