croup

Croup is a common respiratory disease characterized by inflammation of the upper respiratory tract. This pathology causes swelling of the trachea and larynx, as a result of which the patient has difficulty and rapid breathing, a characteristic whistle is heard on inspiration and a characteristic croup (barking) cough takes place. Often, croup, the symptoms of which are more common in preschool children, are diagnosed as laryngitis in adult patients.

Content of the article:
Croup: pathogenesis
Classification of cereals
Causes of croup
Symptoms of croup
Diagnosis of croup
Treatment of croup
Prevention of croup
Croup
Croup is mainly found in children under the age of 4-6 years. This is caused primarily by anatomical features of the structure of the upper respiratory tract. In older children, the airways are wider, the cartilage in the walls is less elastic, with inflammation, the effect of mucosal swelling is not so critical, significant. Parents who have noticed croup symptoms in their child for the first time often panic. Do not be afraid — you should immediately go to a pediatrician or a general practitioner. Timely diagnosis is the key to successful treatment.

Croup: pathogenesis
Croup occurs in various inflammatory diseases of the respiratory system, changes in the vocal cords and the sublingual space. During the survey, patients often complain of a barking cough, and the patient’s voice is hoarse and hoarse. Changes in the tissues of the respiratory tract, swelling of the laryngeal mucosa, lead to narrowing and deterioration of the lumen, the air flow is accelerated, which causes rapid breathing, drying of the mucous membrane and the formation of a crust, which further reduces the lumen of the larynx. It becomes difficult for the child to breathe and then the auxiliary muscles of the chest turn on, which, when visually examined, looks like its protrusion. Due to this, there is an elongated inhalation, through a narrowed inflamed larynx, the pause between inhalation and exhalation increases, breathing is accompanied by a characteristic noise (stenotic breathing). Thus, the lack of oxygen is partially compensated, the necessary gas exchange in the lungs is maintained. But, despite this, the minute volume of oxygen in the lungs still decreases, even with an increase in the degree of laryngeal stenosis, part of the blood in the pulmonary sac is not oxygenated and is thrown into the arterial circulatory system of a large circle. This condition eventually leads to arterial hypoxia, and then to hypoxemia. The latter should be regarded as the beginning of decompensation of lung function. It is important to understand that the greater the narrowing of the larynx, the more pronounced hypoxia will be, which adversely affects all organs and systems. Hypoxemia causes tissue hypoxia, later — severe disorders of cellular metabolism with pronounced changes in the cardiovascular, central nervous, neuroendocrine, and other vital systems of the human body.

It should also be borne in mind that in addition to the mechanical factor in the pathogenesis of croup in acute respiratory diseases, reflex spasm of the laryngeal muscles plays a major role, which is characterized by increased stenotic breathing, up to asphyxia. With croup, the child’s psychosomatic state is also disturbed — anxiety occurs, the baby is very capricious and he has a feeling of fear. For this reason, the use of sedatives in the complex therapy of croup is considered effective, in this case there is an improvement in the child’s breathing.

Separately, it should be noted that the accumulation of thick bacterial mucus in the vocal cavity, the formation of crusts and necrotic and fibrinous overlays leads to the appearance of purulent laryngotracheobronchitis and laryngitis. The analysis often reveals streptococcus, Staphylococcus, and other gram-negative flora.

Predisposing factors include paratrophy, childhood eczema, drug allergies, birth injuries, frequent acute respiratory diseases of the respiratory tract.

Classification of cereals
In otolaryngology, there are concepts of true and false croup. The latter has a bacterial or viral etiology. False croup is classified according to the degree of pathology of the respiratory tract, changes in the mucous membrane of the larynx:

Grade I — with compensated stenosis;
Grade II — with subcompensated stenosis;
Grade III — with decompensated stenosis;
IV degree — in the terminal stage of stenosis.
True croup consistently passes from one stage to another. Based on this, it is possible to distinguish: the catarrhal (dystrophic) stage of the disease, the asphyxic and stenotic stages of the croup.

Causes of croup
Croup occurs when the mucous membrane swells, swelling of the trachea and larynx. This pathology of the respiratory system is often caused by other common respiratory diseases (ARVI or influenza). Also, often the symptoms of croup are manifested in allergic reactions to various stimuli, seasonal natural phenomena. Less often, croup is a complication of diphtheria.

Often, croup develops due to an infectious lesion of the cartilage (epiglottis), which blocks the entrance to the larynx when swallowing saliva. The child has general changes in the somatic state: weakness, fever, painful swallowing, dry mouth, etc.

Symptoms of croup
The child has a characteristic barking cough and whistling sounds when entering and exhaling air. The face when coughing acquires a reddish hue from the tension that the patient experiences when coughing, expectorating accumulated bacterial mucus. It is worth paying attention to the complexion, if the color is paler than usual, and the lips have a bluish hue, it means that the child is not just hard to breathe, and the body does not receive the necessary amount of oxygen. With such indicators, immediate hospitalization of the child in a specialized hospital is recommended. A high temperature may indicate a croup of a severe infectious nature, for example, diphtheria or epiglottis. His health, and sometimes his life, will depend on how quickly the child gets into the hands of doctors.

Various pathologies of the upper respiratory tract and, as a consequence, narrowing of the walls of the laryngeal lumen lead to breathing problems. The air flow becomes more frequent, the so-called shortness of breath appears, which is accompanied by the retraction of the jugular fossa and intercostal space. The pectoral muscles are incorrectly involved in the respiratory process: when inhaling, the chest decreases, when exhaling, it expands. Too active breathing leads to drying of the mucous membrane and the formation of a crust. Thus, there is an even greater narrowing of the laryngeal lumen, breathing is extremely difficult, a characteristic whistle is heard. With an abundant accumulation of mucus in the lumen of the larynx, the vocal cords are hoarse, the voice is hoarse. The variability of breathing sounds indicates the dominance of spastic components of obstruction. A decrease in the intensity of noise during breathing may signal an aggravation of stenosis.

Diagnosis of croup
According to the symptoms, croup resembles any respiratory infectious disease of the upper respiratory tract. Croup is diagnosed according to the identified three symptoms: difficulty breathing, a settled voice and a rough, barking cough. Taking into account the general picture of the disease, diagnosis is not difficult for a doctor. There is a whole group of diseases of the respiratory system that the doctor needs to exclude, but often one disease pulls all the symptoms of croup. A pediatrician or an otolaryngologist can diagnose the disease. Depending on the course and stage of inflammation of the laryngeal mucosa, laryngoscopy may be necessary. To determine the level of oxygen in the blood, a pulse oximeter is used. With bronchopulmonary infectious complications, a pulmonologist will need to be examined. If there is syphilis, then croup is diagnosed together with a venereologist. Tuberculosis patients will need to consult a phthisiatrician.

After other pathologies are excluded and the final diagnosis of croup is established, treatment is prescribed in accordance with the general clinical picture. In the last study, rough wheezing with a characteristic whistle is heard in the lungs. Wheezing signals an exacerbation of the disease. Since bacterial mucus is collected in the larynx, it will be necessary to take a smear for bacteriological culture in order to identify the verification of the pathogen. It will be necessary to conduct PCR tests, RIF and ELISA studies. Laryngoscopy data will help to find out the degree of narrowing of the laryngeal walls, the inflammatory process, to detect fibrinous films characteristic of diphtheria. Complications require additional studies: otoscopy, lumbar puncture, pharyngoscopy, rhinoscopy, paranasal sinuses and lung radiography.

True and false croup: differential diagnosis
If the patient has an established diagnosis of croup, the symptoms and treatment depend on the clinical picture of the course of the disease. False croup is diagnosed only with diphtheria and is accompanied by inflammation in the vocal cords. With false croup, inflammation affects, in addition to the vocal cords, also the mucous membrane of the larynx, trachea, up to the bronchi. False croup is diagnosed in all other respiratory tract diseases (acute respiratory infections, parainfluenza, influenza, etc.), except diphtheria.

The main symptoms of a true croup of diphtheria etiology are a barking cough, a hoarse voice, difficulty in inhaling and exhaling — stenotic breathing. Similar symptoms of croup develop incrementally, within 4-5 days. After that, the hoarse voice is replaced by aphonia, and the barking rough cough becomes soundless. With appropriate treatment, there is a gradual elimination of symptoms: the stenosis decreases and disappears completely, the cough disappears, the voice is completely restored.

The first manifestations of false croup occur suddenly and often also suddenly disappear. This form of pathology is characterized at first by sudden stenosis during daytime or nighttime sleep. True croup ends with stenosis, and as a consequence, asphyxia. With isolated true croup, the general specific intoxication is not clearly expressed, the course of the disease depends on the nature of hypoxia.

With the flu, the symptoms of croup appear in the first 1-2 days of the disease, or already during the second wave of the disease. Croup on the background of influenza can be different: from mild to extremely severe.

At the first manifestations of croup, there is often an increase in temperature around 39 °, runny nose, severe chest cough, symptoms of intoxication (lethargy, fatigue, headache, drowsiness, in case of complications — convulsions, disorder of consciousness).

Treatment of croup
In case of diagnosis of true diphtheria croup, patients are immediately hospitalized. Treatment is carried out in a complex with antispasmodic, antihistamines and sedatives. Drug treatment is prescribed in accordance with the indicators of diagnostic studies, bacteriological seeding and other diagnostic measures. The effectiveness of treatment directly depends on the stage at which the disease is developing. It is customary to prescribe intravenous or intramuscular administration of anti-diphtheria serum. Detoxification therapy is practiced — drip administration of glucose and various sorbents, prednisone is used according to the doctor’s prescription.

Depending on what kind of cough the patient has, they use: antitussive agents (oxeladin, glaucin, codeine, etc.) — with a dry cough, mucolytics (acetylcysteine, carbocysteine, ambroxol) — with a wet, expectorant cough with copious sputum separation.

In severe laryngeal stenosis, the doctor may prescribe glucocorticosteroids. If the croup is of an acute viral infectious nature, appropriate antiviral drugs are prescribed. Antibiotic treatment is necessary to prevent secondary bacterial infection of the patient. With symptoms of hypoxia, oxygen therapy is applicable, inhalation treatment is carried out.

Prevention of croup
To prevent diphtheria true croup, babies are vaccinated at the age of three months. False croup does not imply any preventive measures. The most important thing is to provide the baby with a healthy immune system. It is to children with a weakened immune system that all imaginable and unthinkable diseases “stick”. Proper nutrition, which includes all the necessary nutrients, regular walks and sleep, wellness and hardening procedures — this is not a complete list of activities that help maintain the baby’s immunity at the right level. Love your baby, seek medical help in a timely manner and all diseases will bypass you!

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