Pharmacological treatment of the patients with croup

Background: Croup is a respiratory illness usually caused by acute viral infection of the larynx, trachea, and bronchi, and characterized by the abrupt onset of a barking cough, inspiratory stridor, hoarseness, and respiratory distress due to upper airway obstruction. Croup commonly affects children younger than 6 years of age, with peak incidence between 7 and 36 months. Although the disease is usually self-limited, it may occasionally become life threatening, and can, on rare occasion, lead to respiratory failure.Current Concepts: Treatment of viral croup depends on the severity of symptoms as denoted by Westley croup score (i.e., mild, moderate, or severe). A single dose of oral or intramuscular dexamethasone (0.15-0.6 mg/kg) is the mainstay of treatment for viral croup, irrespective of severity. A single dose of nebulized budesonide (2 mg) is equally effective as systemically administered dexamethasone, and is considered when a patient is unable to take a medicine orally. Nebulized L-epinephrine (1:1,000, 3-5 mL) causes vasoconstriction in the mucosa, rapidly reducing airway edema. Addition of nebulized L-epinephrine is indicated in the patients with croup of at least moderate severity, displaying chest retraction and signs of labored breathing.Discussion and Conclusion: The most effective pharmacological treatments for patients with viral croup are oral or intramuscular dexamethasone, and nebulized L-epinephrine. Especially, corticosteroids can significantly decrease the intensity of croup symptoms and reduce hospital admissions, return visits to emergency department and length of stay in the hospital.

Recurrent episodes of viral croup in children: potential causes and approaches to its prevention

Viral croup is one of the most common causes of upper respiratory tract obstruction in children under 6 years of age. Frequent acute respiratory infections (ARIs) and a burdened history of allergies might be triggers for recurrent episodes of viral croup. Purpose — to study vitamin D status in infants with viral croup and the efficacy of cholecalciferol supplements for recurrent episodes prevention. Materials and methods. Hospital(based survey included 128 children aged 4–36 months with viral croup. Vitamin D status was evaluated by measuring serum 25 (OH) D levels. Control studies were performed after 12 weeks. A prospective follow(up study lasted for three years. Results. 32.8±4.1% (42/128) of hospitalized children with viral croup had a history of frequent episodes of ARIs (>6 episodes per year). Recurrent episodes of viral croup were more frequent in children with a burdened history of allergies compared to those who did not have allergies — 46.4±9.4% (13/28) vs. 23.0±4.2% (23/100) (р=0.028). At the time of enrollment, 47.6±4.4% (61/128) of children had optimal concentration of 25 (ОН) D (30–100 ng/ml). Serum 25 (OH) D levels in children who regularly received supplements were 33.5 ng/ml (27.2–44.5) at the time of control. Patients with a level of 25 (OH) D>30 ng/ml were less likely to have recurrent ARIs (0/29) during the observation period compared to those with a level of 25 (OH) D 20–30 ng/ml (25.0±10.8%, 4/16) (p=0.023). In children with a concentration of 25 (OH) D>30 ng/ml, the risks for recurrent episodes of viral croup in the future were 9 times lower (OR=9.00; 95% CI: 1.55–52.27), and the risks of more mild viral croup course were 11.4 times lower (OR=11.40; 95% CI: 1.20–108.29). Conclusions. Insufficient levels of vitamin D were recorded in 46.1±4.4% of children with viral croup. When the concentration of 25 (OH) D in serum increased to >30 ng/ml, the frequency of recurrent ARIs decreased (p=0.023); the risks for recurrent episodes of viral croup decreased, as well as the risks of more severe viral croup course. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: recurrent episodes, viral croup, children, causes, prevention.