Pseudocroup Causes and Treatment

Symptoms

Pseudocroup is usually preceded by a viral infection such as a cold or flu with nonspecific symptoms such as cough, runny nose, and fever. This soon develops into the following typical symptoms:

  • Barking cough (similar to a seal), which worsens with anxiety and excitement
  • Whistling breath sounds, especially when inhaling (inspiratory stridor), difficulty breathing.
  • Hoarseness
  • With or without fever

The symptoms often occur at night and last only about two days to a maximum of one week. The course is usually mild and the disease goes away on its own. Understandably, however, parents are very concerned when their child struggles at night with a barking cough and difficulty breathing. The disease primarily affects children under 6 years of age, is more common in boys, in the fall and during the cold season. Rarely, adolescents and adults may also become ill.

Causes

Pseudocroup is the result of inflammatory constriction of the upper respiratory tract and usually occurs as a result of a descending viral infection (cold, flu), primarily with parainfluenza viruses, but also with influenza viruses, adenoviruses, metapneumoviruses, measles viruses, rhinoviruses, or RSV, among others. More rarely, bacteria can be the trigger. Infection leads to inflammation, obstruction and narrowing of the tissues below the vocal cords and trachea. The bronchi may also eventually be affected. True croup, diphtheria caused by the bacterium, manifests itself in similar symptoms and can lead to dangerous complications. However, it is no longer seen in many countries because of good vaccination coverage.

Transmission

Direct or indirect contact with secretions from an infected person, such as shaking hands or contact with objects. Contact with a virus-contaminated aerosol transmitted directly from person to person or indirectly through the air.

Complications

Severe complications are rare. They include oxygen deprivation, blue discoloration of the skin, pallor of the skin, increased carbon dioxide in the blood, rapid pulse, clouding of consciousness, and respiratory failure. Fortunately, a fatal outcome due to asphyxia is very rare today because of good medical care.

Diagnosis

Diagnosis is made under medical care based on physical examination and patient history. The child should be comfortable because symptoms worsen with anxiety and agitation. Symptoms can be classified into different degrees of severity, for example, using the Westley score. Differential diagnoses include:

  • A dangerous epiglottitis (inflammation of the epiglottis).
  • A bacterial infection of the trachea
  • Asthma
  • Swallowed objects in the respiratory tract (aspiration).
  • Abscesses
  • Angioedema, allergic reactions
  • Psychogenic stridor
  • Hypocalcemia
  • Diphtheria (true croup) – no longer occurs in many countries.

Non-drug treatment

Parents should remain calm, hold the child upright in their arms and reassure them. Medical treatment is carried out under the care of a doctor. For detailed treatment guidelines, refer to the medical literature. Pseudocroup usually resolves on its own. If complications occur, the doctor must be consulted immediately. Hospitalization may also be necessary.

  • Stay calm during a coughing fit
  • Steam inhalations (e.g. run a hot shower in the bathroom), humidification.
  • Short to the cold air
  • Offer liquid

Drug treatment treatment

NSAIDS:

  • Ibuprofen is effective for fever, pain, and anti-inflammation. It is also available without a doctor’s prescription. Special dosage forms (syrup) are available for children.

Glucocorticoids:

  • Such as dexamethasone (tablet or injection), bethametasone (water-soluble tablets), and budesonide (inhalation) are anti-inflammatory, vasoconstrictor, and decongestant, and are considered effective and 1st-line agents in the literature. They can be administered by inhalation, parenterally, orally or possibly rectally (Germany: Infectocorticroup). Often a single dose is sufficient.A possible problem is the immunosuppressive effects and superinfections, but especially with repeated doses.

Epinephrine:

  • Adrenaline inhalations (epinephrine) facilitate breathing and quickly improve respiratory problems. The effect occurs within about 10-30 minutes and lasts only briefly, during 2 hours. Adverse effects include a rapid pulse. Adrenaline is administered for moderate to severe pseudocroup. Both racemic and pure L-adrenaline are effective.

Oxygen:

  • Is administered to children with low oxygen saturation (hypoxia). Rarely, intubation is necessary.

Aconitum in homeopathic potency is recommended as an alternative medicine remedy. Not recommended therapies: The use of cold remedies, cough-irritant drugs such as dextromethorphan or codeine (respiratory depressant! ), beta2-sympathomimetics such as salbutamol or decongestants is not recommended in the literature. Antibiotics are ineffective because the disease is usually caused by viruses (exception: bacterial infections).