Brief overview
- Symptoms: Seizure-like, dry, barking cough; possibly shortness of breath; fever, hoarseness, whistling breath sounds, weakness, general feeling of being ill.
- Causes and risk factors: usually caused by various cold viruses, very rarely by bacteria; promoting factors: cold winter air, air pollution, cigarette smoke, existing allergies
- Treatment: cortisone suppositories, antipyretics; in case of severe respiratory distress, treatment in hospital (with cortisone, adrenaline, possibly oxygen supply).
- Prognosis: Usually heals by itself within a few days; very rarely complications such as pneumonia, otitis media.
- Prevention: Prevent colds in general; if you have a cold, ensure sufficient humidity, avoid tobacco smoke; vaccination against some of the causes such as measles, chickenpox, influenza is possible.
Pseudocroup (croup cough) is an acute infection of the larynx above the glottis and the trachea. It is usually caused by various cold viruses. The germs infect the upper respiratory tract, causing the mucous membranes in the throat, nose and pharynx to swell considerably and narrow the airways. In addition, there are muscle cramps (spasms) in the lower larynx and upper trachea.
Most cases of pseudocroup occur in the fall and winter months. Children between one and five years of age are usually affected – boys slightly more often than girls. Most children get a croupy cough once or twice in their lives. Occasionally, croup in children occurs more often or even beyond the typical age period. Often these are children who are prone to asthma.
Pseudocroup in adults is very rare.
Pseudocroup is not the same as croup
Pseudocroup and croup are not the same. The “real” croup is a potentially life-threatening laryngitis in the context of a diphtheria infection. However, this infection has become so rare thanks to widespread vaccination that the term “croup” is colloquially used as a synonym for pseudocroup. Croup syndrome has also become a synonym for pseudocroup.
What is the course of a pseudocroup attack?
Is pseudocroup contagious?
The cause of pseudocroup is usually various cold viruses. When patients cough, speak and sneeze, they spread tiny droplets of saliva in the environment that are infected with the viruses that trigger the disease. Other people may breathe in these infectious saliva droplets and then possibly fall ill themselves (droplet infection).
In this respect, the infection is usually contagious – but usually only as a “normal” cold. Whoever is infected does not necessarily have to develop the symptoms of pseudocroup such as croup cough, but may only suffer from a cold with the corresponding different symptoms.
In the case of pseudocroup, pay increased attention to hygiene and keep your sick child away from other children if possible. For example, do not send it to kindergarten until it has recovered.
The classic symptom of pseudocroup is a dry, barking cough (croup cough) that usually occurs at night. This nocturnal accumulation is probably due to the fact that cortisol levels in the body drop to their lowest level between midnight and four o’clock. The effect of the anti-inflammatory hormone is therefore lowest during this phase.
It is also possible that small pits (retractions) form in the spaces between the ribs. With increasing oxygen deficiency, fingertips and lips turn blue (cyanosis). Sufferers experience anxiety and restlessness, which intensifies the acute symptoms.
Other symptoms of pseudocroup include:
- Fever
- Hoarseness
- Difficulty breathing in with whistling or “squeaking” breath sounds (inspiratory stridor)
- General feeling of illness
- Weakness
Because pseudocroup usually develops as a result of a cold, a cold and normal cough are also included among the symptoms of pseudocroup in the early stages of infection.
Pseudocroup in adults
Pseudocroup stages
Based on the symptoms, pseudocroup can be divided into four degrees of severity (stages):
- 1st stage: typical barking pseudocroup cough, hoarse voice
- 2nd stage: Breathing noises when inhaling, pulling in of the chest during inhalation
- 3rd stage: shortness of breath, increased pulse rate, anxiety, pale complexion
- 4th stage: severe shortness of breath, shallow and rapid pulse, breathing sounds when inhaling and exhaling, blue coloration of the skin, impaired consciousness
Causes and risk factors
- Parainfluenza viruses
- Influenza viruses (type A or B)
- RS, rhino, adeno and metapneumo viruses
Less frequently, measles, chickenpox, herpes simplex and Epstein-Barr viruses are responsible for the disease.
As a result of the viral infection of the mucous membranes in the mouth, nose and throat, the vocal cords below the larynx swell. It is also possible for increased mucus to accumulate in the bronchial tubes. This causes symptoms such as hoarseness and shortness of breath.
Pseudocroup symptoms are often worsened by various factors. These include air pollution and cigarette smoke. Allergies also have a favorable effect.
Sometimes pseudocroup is caused by bacteria. In some cases, for example, an infection with the bacterium Staphylococcus aureus or with pneumococcus triggers pseudocroup. Allergies may also cause the typical barking croup cough. This is known as spastic croup.
A doctor usually recognizes pseudocroup by the typical cough and the whistling sounds when breathing in. In addition, he will ask more detailed questions about the symptoms in order to obtain a medical history. Possible questions are:
- How long has the cough been present?
- How often do the coughing episodes occur?
- Are there other symptoms?
- Is there also shortness of breath?
Finally, it is important to distinguish possible pseudocroup from epiglottitis. This disease shows similar symptoms to pseudocroup, but is often life-threatening. For clarification, the doctor examines the patient’s throat: The tongue is pushed down with a small spatula so that the physician has a clear view. The examination does not take long and is painless.
X-ray of the chest (chest x-ray) is usually not necessary, but it helps if the diagnosis is unclear.
Treatment
If the doctor has diagnosed moderate or severe croup, children in particular are always treated in hospital. This means that professional help is quickly available for emergencies (severe acute respiratory distress). Adults usually only suffer from mild pseudocroup, which is why they are very rarely treated as inpatients.
First aid for an attack of pseudocroup
Cold makes the airways swell and the attack subside. Therefore, you or your child should do the following during an acute attack of croup:
- Breathe in cool air, at an open window or outside on the balcony or in the garden.
- Raise the upper body of the affected person
- Take cool drinks (in small sips, water or tea, no milk)
- Calm yourself or your child, as anxiety increases symptoms.
In a severe attack of pseudocroup, the typical coughing attack is accompanied by signs of oxygen deficiency (pale skin, bluish lips, shortness of breath, rapid heartbeat, anxiety, etc.). In this case, call the emergency doctor immediately!
For a long time, it was recommended to inhale moist air during an acute attack of pseudocroup (humidifying the air, for example, with the help of nebulizers, humidifiers or moist towels). However, it has not been scientifically proven that this helps.
Home remedy
Inhalations are not suitable for babies and children due to the risk of scalding! Even as a teenager or adult, be careful not to burn yourself or tip the bowl!
Lavender oil chest compresses or teas made from mallow, lavender and valerian are considered other proven home remedies in the supportive treatment of pseudocroup.
Homeopathy
Some parenting guides recommend treating pseudocroup with homeopathic remedies. The remedies of choice are considered to be Aconitum napellus in the initial phase, for the night Spongia tosta and to prevent a new attack in the morning Hepar Sulfuris as well as Aconitum or Belladonna.
However, the effectiveness of homeopathic remedies has not been scientifically proven.
Course of the disease and prognosis
Most cases of pseudocroup belong to the first stage and heal on their own without any problems. Only very rarely do complications develop, such as otitis media or pneumonia.
Duration
Pseudocroup generally lasts between two days and two weeks, depending on the general health of the affected person. Rarely, pseudocroup attacks occur repeatedly over a long period of time.
Prevention
If your child suffers from a cold (flu-like infection), avoid possible factors that promote croup. Ensure sufficient humidity (especially in the heating season), do not expose the child to tobacco smoke if possible. Pediatricians generally recommend refraining from smoking in the home if children regularly spend time there. Passive smoking generally increases the risk of pseudocroup for children.
