Viral Croup: A Current Perspective

Alexander K.C. Leung, MBBS, FRCPC, FRCP (UK & Irel), FRCPCH; James D. Kellner, MD, FRCPC; David W. Johnson, MD, FRCPC

Disclosures

J Pediatr Health Care. 2004;18(6) 

In This Article

Abstract and Introduction

Viral croup is the most common cause of upper airway obstruction in children 6 months to 6 years of age. Parainfluenza virus accounts for the majority of cases. The disease is characterized by varying degrees of inspiratory stridor, barking cough, and hoarseness because of laryngeal and/or tracheal obstruction. The diagnosis is mainly a clinical one and diagnostic studies usually are not necessary. The management has altered dramatically in the past decade. Good evidence exists to support the routine use of corticosteroid in all children with croup. Intervention at an earlier phase of the illness will reduce the severity of the symptoms and the rates of return to a health care practitioner for additional medical attention, visits to the emergency department, and admission to the hospital. Most children respond to a single, oral dose of dexamethasone. For those who do not tolerate the oral preparation, nebulized budesonide or intramuscular dexamethasone are reasonable alternatives. Nebulized epinephrine should be reserved for patients with moderate to severe croup. Simultaneous administration of corticosteroid and epinephrine reduces the rate of intubation in patients with severe croup and impending respiratory failure.

Viral croup (laryngotracheobronchitis), a clinical syndrome caused by various viral agents, is characterized by varying degrees of inspiratory stridor, barking cough, and hoarseness as a result of laryngeal and/or tracheal obstruction. The word "croup" is derived from the Anglo-Saxon word kropan which means "to cry aloud" (Cherry, 2004). Croup is one of the most common respiratory illnesses and the most common cause of upper airway obstruction in children 6 months to 6 years of age (Griffin, Ellis, Fitzgerald-Barron, Rose, & Egger, 2002). In the majority of cases, the disease is mild and self-limited. Nevertheless, it poses a large burden on the health care systems. Occasionally, it may cause severe respiratory obstruction, and hospitalization rates of 1.3% to 2.6% have been reported (Peltola, Heikkinen, & Ruuskanen, 2002). The management of croup has undergone dramatic changes in the last decade because of our increased awareness of the benefits of steroid treatment. This article reviews the current approach and treatment of croup.

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