croup
CROUP
Croup is a viral infection that causes erythema and edema of the tracheal walls and narrowing of the subglottic region. It is often characterized by an acute, rapidly progressing respiratory disease.
It is a medical emergency in children and requiring immediate treatment.
Most common causes are parainfluenza virus 1&2 and respiratory syncytial virus.
Occurrence of symptoms is usually at night and with abrupt onset and improve during daytime.

Pharmacotherapy

Epinephrine (Nebulized)
  • Should be given to patients w/ severe respiratory distress
  • Reduces symptoms w/in min but exerts no effect beyond 1 hr
  • Hold discharge & observe patient for at least 2 hr after administration of Epinephrine
  • Nebulized Epinephrine w/ oral Dexamethasone is indicated for moderate to severe croup
Corticosteroid (Systemic)
  • Eg Dexamethasone, Prednisolone
  • Should be given to children diagnosed w/ croup
  • Improves symptoms & reduces risk of hospital admission
  • Well-absorbed, relatively safe
  • Multiple doses do not provide additional benefit over a single dose
  • Should not be given to a child w/ known immune deficiency or recent varicella exposure
Dexamethasone
  • Recommended first-line corticosteroid therapy for croup due to its long half-life
Corticosteroid (Nebulized)
  • Eg Budesonide
  • May be given to children diagnosed w/ croup who are intolerant to Dexamethasone
  • Administration may cause more agitation to the child
  • Not routinely given to a child due to its cost, length of administration & anxiety that it causes
    • Indicated only in patients w/ persistent vomiting & w/ severe respiratory distress
    • Budesonide may be mixed w/ Epinephrine & administered simultaneously

Non-Pharmacological Therapy

Parent/Guardian Reassurance
  • Actions that minimize anxiety are appropriate until the airway is secure
  • Child should be held & comforted
  • Avoid anxiety-provoking maneuvers (eg blood extraction, IV line placement, placing the child in a supine position or direct inspection of the oral  cavity) until the airway is secure
Helium-Oxygen (Heliox) Inhalation
  • Further studies are needed to prove the use of heliox in patients w/ croup
  • May be useful in reducing resistance of airflow & turbulence, thereby decreasing the work during respiration in patients w/ croup
Oxygen Therapy
  • Provide supplemental O2 if necessary
Humidification therapy
  • Also called mist therapy, uses humidified air to help reduce mucosal surface dryness & thickening of secretions
  • Recommended for children hospitalized due to croup
  • Has not been proven to be an effective treatment to reduce croup severity
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Respirology - Malaysia digital copy today!
DOWNLOAD
Editor's Recommendations
Most Read Articles
Pearl Toh, 19 Jun 2016
Infants with persistent rhinitis have a higher abundance of Actinobacteria, especially Corynebacterium spp., in their nasal microbiome compared with healthy controls, according to a Singapore-based study presented at the European Academy of Allergy and Clinical Immunology (EAACI) Annual Congress 2016 held in Vienna, Austria.
Gabriel Angelo Sembrano, 16 Sep 2014

“At present, there is a limited development of new antibiotics. There is also a fast development of resistance to antibiotics. There are pathogens no longer susceptible to all antibiotics, and many pathogens are no longer susceptible to most antibiotics,” said Dr. Andre Villanueva, chief of party of the USAID’s Innovations and Multisectoral Partnerships to Achieve Control of TB (IMPACT) Project at the recent Annual Convention of the Philippine Pharmacists’ Association in Davao City.

Audrey Abella, 06 Jan 2017
Persistent wheeze or childhood asthma may be reduced by fish oil supplementation, particularly n-3 long-chain polyunsaturated fatty acids (LCPUFAs), during pregnancy, a recent Danish study found.
Pearl Toh, 31 May 2016
Synbiotic mixture of oligosaccharides and Bifidobacterium breve (B. breve) M-16V probiotic strain in infant formula restores gut colonisation by B. breve and supports healthy gut development in infants delivered by Caesarean-section (C-section), according to a study presented at the recent European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) annual meeting held in Athens, Greece.