What is Laryngotracheobronchitis (Croup)?
Laryngotracheobronchitis is a big word that simply means inflammation, or swelling, of the larynx (voice box), trachea (windpipe), and bronchi (air passages leading to the lungs). This condition can be more severe than just a swelling of the voice box and windpipe because it affects more parts of the airway. However, it’s hard to tell the difference between the two just through examining the symptoms.
A common term you might have heard for this kind of inflammation is “croup”. For the purpose of this explanation, we’ll use the term “croup” to cover both laryngotracheobronchitis and laryngotracheitis.
Croup is a very common reason for children to have a cough, a noisy breath when inhaling (stridor), hoarseness, and a fever. In most cases, kids with croup recover without any serious problems. But, there’s a small chance, that it can be dangerous for babies.
What Causes Laryngotracheobronchitis (Croup)?
Croup is usually a viral infection that affects the part of your throat just below the vocal cords, and it’s often brought on by a virus called parainfluenza. However, there are other viruses that can also cause croup. These include the respiratory syncytial virus (RSV), rhinovirus, enterovirus, influenza, and adenovirus.
Risk Factors and Frequency for Laryngotracheobronchitis (Croup)
Croup is a condition that usually affects little boys more than girls. It’s most common in kids aged 6 months to 6 years, and especially those from 12 months to 2 years old. Croup usually happens more frequently from late fall to early spring. It’s uncommon for croup to come back again and again, unless it runs in the family. Most of the time, kids who have croup don’t need to stay in the hospital. In fact, between 1999 and 2005, only around 5.6% of children with croup ended up needing to be admitted to the hospital. Most of the time, they can go home from the emergency room after getting the right care.
- Croup is more common in boys.
- It usually affects children aged 6 months to 6 years, especially those between 12 months and 2 years old.
- Croup tends to occur more often from late fall to early spring.
- Recurring croup is not common, unless it’s a family illness.
- Most kids with croup don’t need to stay in the hospital.
- A study from 1999 to 2005 showed that only about 5.6% of children with croup had to be admitted to the hospital.
- Most kids with croup can go home from the ER after they’ve received the appropriate care.
Signs and Symptoms of Laryngotracheobronchitis (Croup)
Croup is a respiratory illness that typically follows one to three days of runny nose, nasal congestion, and fever. Main symptoms of this illness include a cough that sounds like a bark or a seal, a coarse voice, and a high-pitched noise when inhaling, which some parents may mistakenly describe as “wheezing”.
Healthcare professionals often use scoring systems to determine the seriousness of breathing difficulties. The Westley score, for instance, takes into consideration:
- Skin color (looking for blue tint called cyanosis)
- Alertness level
- Noise when inhaling (inspiratory stridor)
- Signs of struggle in breathing (retractions)
- The flow of air coming into the lungs (air entry)
Testing for Laryngotracheobronchitis (Croup)
If someone is experiencing stridor, a harsh sound created when breathing is constricted, the first step is to rule out other causes. Then, the doctor immediately checks for signs that the individual’s ability to breathe is getting worse. X-rays are not always necessary for diagnosing croup, a condition that causes difficulty in breathing and a “barking” cough. However, they can be helpful if the condition isn’t clear. One common sign of croup on an X-ray is the “steeple sign”, a narrowing in the area below the voicebox.
When examining patients, it’s usually best that they stay relaxed and comfortable to avoid making the condition worse. This is often done by letting them sit on their caregiver’s lap. Typical signs of croup include a harsh, barking cough and possibly stridor. If the inflammation has spread to the lower part of the windpipe, known as laryngotracheobronchitis, patients might also show signs of wheezing, crackling sounds when breathing, decreased airflow, and rapid breathing.
Patients with croup can be categorized into three groups based on severity: mild, moderate, or severe. Doctors assess this by looking for worsening stridor, observing any signs of labored breathing, checking vital signs, monitoring mental status, gauging hydration levels, and evaluating air movement. If wheezing, crackling sounds, or decreased air movement is heard upon examining the lungs, this could suggest the presence of laryngotracheobronchitis.
Treatment Options for Laryngotracheobronchitis (Croup)
The goal of treating croup, a condition that causes swelling in the throat resulting in a “barking” cough, is to improve airflow and make breathing easier. Doctors use a mixture of medications and certain techniques, including administering an aerosolized medication known as epinephrine, giving corticosteroids, and observing the patient for three hours after the last dose of epinephrine. If a patient with croup has low oxygen levels, additional oxygen may be provided through a method like a nasal cannula, which is a device that delivers oxygen through small tubes that face into the nostrils.
One of the main types of medication used to treat croup is aerosolized epinephrine. This medication is given through a nebulizer, a device that turns the liquid medication into a fine mist that the patient can breathe in. Epinephrine is typically used for moderate and severe cases of croup. If a patient needs more than one or two doses in the emergency room, they may need to be admitted to the hospital.
Corticosteroids are also used in the treatment of croup, regardless of how severe the condition is. These medicines can help reduce inflammation in the throat. Patients typically only need to take a single dose of these meds.
Observation is another essential part of treating croup. After you’ve been given each dose of nebulized epinephrine, your doctor will want to watch you for at least three hours to see how your symptoms respond. If your symptoms get worse or return during this time, you may need more treatment in the emergency department.
Another treatment that has been tried for croup is Heliox; it’s a mixture of helium and oxygen. The results of its use have been varied, but it’s generally safe to try because it may improve breathing.
Lastly, in severe cases of croup where the other treatments haven’t worked, a procedure called intubation may be necessary. In this process, a tube is inserted into the windpipe through the mouth or nose to allow air to reach the lungs more easily. However, because the throat is usually swollen in people with croup, a smaller-than-normal tube is used to avoid causing any damage.
What else can Laryngotracheobronchitis (Croup) be?
For a child less than 6 months old showing stridor (a high-pitched wheezing sound caused by disrupted airflow), the following conditions could be potential causes:
- laryngotracheomalacia (softness of the vocal cords and windpipe)
- subglottic stenosis (narrowing of the airway below the vocal cords)
- vocal cord paralysis
- hemangioma (a benign tumor made up of blood vessels)
- vascular ring (a congenital malformation of the aortic arch)
- foreign body aspiration (inhaling a small object)
- anaphylaxis (a severe allergic reaction)
- asthma
- peritonsillar abscess (a pus-filled sore around the tonsils)
- retropharyngeal abscess (an abscess behind the throat)
For children older than 6 months with stridor, possible diagnoses include:
- foreign body aspiration
- bacterial tracheitis (a bacterial infection of the windpipe)
- epiglottitis (inflammation of the flap at the base of the tongue)
- peritonsillar abscess
- parapharyngeal abscess (an abscess near the throat)
- retropharyngeal abscess
- anaphylaxis
What to expect with Laryngotracheobronchitis (Croup)
The outcome for most children with croup is generally very good. Most cases can be handled outside the hospital setting. Less than 2% of patients need to stay in the hospital. The use of medicine given through a fine mist breathed in through a mask (known as nebulized epinephrine) and medicines that lower inflammation (known as steroids) has greatly reduced the need for inserting a tube into the airway for breathing assistance (a process known as intubation) for many patients.
Possible Complications When Diagnosed with Laryngotracheobronchitis (Croup)
While complications from the condition are unusual, they can sometimes happen. Some possible problems include:
- Needing to stay in the hospital
- Getting another bacterial infection
- Getting a collapsed lung, also known as pneumothorax
- Developing an ear infection, also known as otitis media
- Becoming dehydrated
- Having swollen or inflamed lymph nodes, also known as lymphadenitis
Recovery from Laryngotracheobronchitis (Croup)
Patients with a mild form of croup, which is a common respiratory problem in children, can generally be sent home from the emergency room after receiving a single dose of steroids. However, they should be given specific instructions on when to return, such as if symptoms worsen.
If a patient has moderate or severe croup, there are a few things doctors need to check before they can be safely discharged. They need to watch the patient for 3 hours after they receive a treatment called epinephrine to ensure that their symptoms don’t get worse or return. This might include symptoms like persistent stridor (a high-pitched, wheezing sound caused by disrupted airflow), increased difficulty in breathing, or hypoxia (lack of enough oxygen). It’s also important for the patient to appear well other than having croup and be able to drink fluids normally.
In addition to these medical considerations, doctors will also want to make sure that the person taking care of the child can notice if the child’s symptoms improve, has reliable transportation to bring the child back to the hospital if needed, and there are no significant social issues that might affect the child’s care and recovery.
