Croup Cough: Symptoms, Cause, Treatment
What is croup cough? 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 cough 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 childs 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.
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 cough attacks.
Reference pages: Breathing norms and the DIY body oxygen test:
- Breathing norms: Parameters, graph, and description of the normal breathing pattern
- Body-oxygen test (CP test) : How to measure your own breathing and body oxygenation (two in one) using a simple DIY test
References: pages about CO2 effect:
- 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 body tissues
- Nerve stabilization: Carbon dioxide has powerful calmative and sedative effects on brain neurons and nerve cells
ReferencesMoore 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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