False croup or asthma? How to distinguish them and how to help during an attack

Mothers who have at least once seen a child develop an acute attack of false croup literally before their eyes (and most often on a dark night) are unlikely to forget this episode. At the same time, parents often panic, which, of course, does not solve the problem, but only further frightens the kids. You must act confidently and calmly.

Cough is an unconditional innate protective reflex that facilitates the process of clearing the respiratory tract of foreign bodies, toxins and excess mucus, emphasizes the Honored Doctor of the Russian Federation, Director of the University Children's Clinical Hospital, Doctor of Medical Sciences, Head of the Department of Childhood Diseases of the Faculty of Medicine of the First Moscow State Medical University. I. M. Sechenova, professor Natalya Geppe . But it is also one of the most common symptoms of many diseases. In addition to colds and ARVI, there are many other reasons for its occurrence. False croup is one of them. An attack of this disease in a child, as a rule, makes a strong impression on parents.

Night guest

False croup, or stenosing laryngotracheitis, is one of the manifestations of ARVI. It occurs in the larynx, where swelling forms, which interferes with the breathing process. A viral disease does not necessarily have to be severe for an attack to develop. Sometimes the child had only a slight runny nose and a slight cough the day before.

As a rule, false croup occurs closer to the night, but a few hours before this, the child already begins to experience warning signs. Due to the narrowing of the airways, the baby's voice becomes hoarse and a whistling sound appears when breathing. Hearing this, sometimes parents begin to suspect that their child has begun to develop bronchial asthma. But in fact, any doctor who hears such a sound will understand that this is not so. Indeed, with obstruction of the lower respiratory tract (bronchial asthma), the patient inhales normally (problems arise only with exhalation), but with false croup, on the contrary, it is not exhalation that is difficult, but inhalation. The child inhales noisily, making the so-called inspiratory breath. In addition, with false croup, a special cough occurs - barking. For some, it resembles the caw of a crow or even the sound of iron on glass. As the airway narrows, symptoms increase, requiring emergency medical attention. If necessary, emergency doctors will give the child an injection of glucocorticosteroids. Of course, not every child’s false croup can reach the suffocation phase, but if there is a predisposition to such a complication, it is better to have such drugs in your home medicine cabinet.

What to do after a coughing attack?

In the room where the baby spends time, you need to constantly maintain a flow of cool and humid air. If you have a humidifier, it should be running constantly. You can place a pillow under the mattress on the side of your baby's head to give him an inclined sleeping position. You need to prepare more warm drinks.

If you don't have a nebulizer at home, we highly recommend purchasing one. When treating laryngitis, inhalation is your indispensable assistant, and this device works much more effectively than simple steam breathing. Remember that ultrasound is not suitable, since the pulmicort is destroyed in it. It is best to buy a mesh inhaler - they are so compact that they even fit into your pocket, and this is very convenient if you need to go on a trip or travel.

And, of course, if your baby has an attack, you need to make an appointment with a pediatrician as soon as possible to determine the cause and quality treatment. If your child has other symptoms of illness, such as fever, or feels unwell, it is better to call a pediatrician at home. In other cases, the pediatrician can see the patient in the clinic.

Come on, open your mouth

Most often, false croup occurs in children at 2-3 years of age, can recur for several years, and then goes away. If false croup occurs in a child for the first time, it is better for parents to call an ambulance. Doctors will give the child clear instructions on what to do if the situation repeats. Thus, they can stop a new attack themselves.

But inexperienced mothers and fathers are better off seeking medical help. After all, false croup can be confused with Quincke's edema, which occurs as a result of allergies, a retropharyngeal abscess, or, for example, with a foreign object getting into the throat.

If a child (especially in the first years of life) coughs suddenly, against the background of complete health, the first thing you should worry about is whether this is due to aspiration of the respiratory tract. After all, children often put everything in their mouths while playing, which is why toys containing small parts have age markings and should not be given to children under 3 years of age. With such a cough, urgent help is required. By the way, a foreign body in the respiratory tract not only interferes with breathing, but can also cause recurring pneumonia.

How to identify false croup?

It's almost impossible to miss it. Its main signs are a barking dry cough, hoarseness of voice, difficulty breathing, fear, and the body assumes a forced position. Problems with breathing air can also occur for some other reason (allergy, abscess, ingestion of a foreign body), so a hoarse voice remains the key symptom. It is important that exhalation does not cause difficulty (if it does, this may be a sign of asthma, obstructive bronchitis or another disease).

Most often it affects children under 3-5 years of age. With age, the respiratory lumen expands, so adolescents and adults practically do not encounter this problem. Some children are predisposed to seizures, so they may recur.

Is this bronchospasm?

With asthma, a special paroxysmal dry cough with shortness of breath and wheezing also occurs. A child suffering from such a cough should definitely be shown to a pulmonologist, although it may not be asthma, but, for example, bronchospasm. Some children (usually preschool age) are prone to its development. This is a feature of their physiology. But you still can’t ignore such a symptom; you need to deal with it carefully, without putting it off for later. After all, 80% of children with bronchial asthma develop the disease in the first 5 years of life.

It is important to listen to the exhalation. If, as you exhale, the patient emits a high, thin whistle that can be heard even from a distance, you can already suspect that this is not a case of an ordinary ARVI. Although viral infections can become a trigger for asthma.

To alleviate the child’s condition, doctors can use glucocorticoid drugs (can be administered in the form of tablets orally, intravenously or through a nebulizer, as well as rectally in suppositories). Usually on the second day the child feels better, and after a week the baby recovers.

Causes of the disease

The etiology is usually viral - parainfluenza viruses, especially type I, cause the disease in 75% of cases. Relatively common causes of false croup in children are respiratory syncytial virus, adenovirus and human coronavirus. The infection is usually spread by inhaling contaminated air, or by contact with objects that an infected person has come into contact with.

Influenza is a relatively rare cause that requires longer hospitalization and has an increased risk of another attack. Rhinovirus, enterovirus, and herpes simplex are sporadic causes of mild croup.

It is also possible to develop against the background of bacterial infection with mycoplasma, streptococcus, chlamydia, Staphylococcus aureus, etc. Diphtheria was the most common form of fatal stenosing laryngitis in another era, but now this disease is practically absent thanks to vaccination of the population.

Stages of the disease

As laryngeal stenosis progresses during false croup, the following stages are distinguished:

1. Compensated stenosis. Inspiratory shortness of breath that occurs during physical or emotional stress is noted, i.e., inhalation is difficult.
2. Subcompensated stenosis. Inspiratory dyspnea is observed not only during exercise, but also at rest.
3. Decompensated stenosis. Characterized by severe shortness of breath of inspiratory or mixed nature. In some cases, paradoxical breathing may develop, in which the volume of the chest increases during exhalation and decreases during inhalation.
4. Terminal stenosis. Accompanied by the development of severe acute respiratory and cardiovascular failure, severe hypoxia. This stage of the disease often ends in death.

Treatment of false croup is aimed at stopping the attack and preventing its reoccurrence, relieving swelling and inflammation of the laryngeal mucosa.

Symptoms and signs

Symptoms of false croup:

• hoarseness of voice;
• dry barking cough;
• labored breathing.

Acute stenosing laryngotracheitis is characterized by the presence of three symptoms simultaneously:

• annoying, rough barking cough:
• hoarseness, hoarseness of voice - dysphonia;
• so-called inspiratory stridor - difficult whistling, wheezing, bubbling breathing.

In addition to the above symptoms, the patient may have other signs of the underlying disorder, including:

• fever (increased body temperature);
• rhinitis (runny nose);
• discharge from the conjunctiva (usually due to adenoviral infection), lacrimation.

It should also be noted that the described condition usually develops in the evening or at night during sleep, when the child is in a horizontal position.

In practical medicine, it is customary to distinguish 4 stages of acute stenosing laryngotracheitis:

1. Compensated stenosis. The child's condition is assessed as moderate. His consciousness is clear. At rest, breathing is free and even; with motor or emotional excitement, shortness of breath appears - when breathing, retraction of the jugular fossa (located above the sternum) and intercostal spaces is noticeable. The heart rate is 5 to 10 percent higher than normal for a given age. A rough barking cough occurs periodically.
2. Subcompensated stenosis. The patient's condition is serious. The child is excited, his skin is pale, around the mouth there is a cyanotic tint. At rest, shortness of breath is noted - a loud inhalation with retraction of the intercostal spaces, jugular and supraclavicular fossae. The bubbling breathing is interrupted by bouts of rough, deep, barking cough. The voice is significantly hoarse. The heart rate is 10 to 15 percent higher than normal.
3. Decompensated stenosis. The child's condition is extremely serious. There is confusion, pronounced lethargy, or, conversely, agitation. There is inspiratory shortness of breath with extremely difficult inhalation, which is accompanied by a sharp retraction of the supraclavicular and jugular fossae, intercostal spaces, and epigastric region (the area under the sternum - between the ribs and the navel). Exhalation is reduced, the skin is pale, and cyanosis spreads. The heart beats more than 15 percent faster than normal. Blood pressure drops.
4. Asphyxia is a child’s condition that is extremely serious. There is no consciousness. Skin with a bluish tint (cyanotic). The pupils are dilated. Breathing is shallow, infrequent or absent altogether. Heart sounds are muffled and their frequency is very difficult to calculate. The pressure is sharply reduced. Convulsions are possible.

Prevention

There is no medicine to prevent laryngeal stenosis. It is useless to give a child immunomodulatory drugs. Even those children who are in good health are not immune from false croup.

To prevent illness it is recommended:

1. Ventilate the apartment more often.

2. Provide daily wet cleaning.

3. Dress your child according to the season.

4. Walk outdoors every day.

5. Limit allergenic foods when you have a cold.

Diagnostics

Diagnosis is not difficult. The diagnosis is made by an emergency physician, pediatrician or otorhinolaryngologist based on medical history (the condition developed against the background of acute respiratory viral infection), the typical clinical picture of false croup (the triad of symptoms described above), the results of an objective examination of the patient (visual examination, assessment of breathing patterns, cardiac activity, monitoring of indicators blood pressure). In a hospital setting, laryngoscopy is performed (for the purpose of visually assessing the condition of the mucous membrane), taking a smear from the throat, followed by microscopic examination and culture on a nutrient medium (to verify the pathogen). In order to assess the degree of oxygen starvation of the body, a study of the gas composition of the blood and the acid-base state is carried out.

According to indications, in order to diagnose the underlying disorder or possible complications, the following may be carried out:

• otoscopy;
• X-ray of the paranasal sinuses and lungs.

Differential diagnosis

False croup must be differentiated from true diphtheria croup, acute epiglottitis, retropharyngeal abscess, foreign body in the larynx and acute obstructive bronchitis.

• True diphtheria croup is accompanied by a low (subfebrile) temperature and a hoarse voice (the patient seems to be “talking through his nose”). There are no runny nose or other catarrhal symptoms. Signs of stenosis develop gradually. When examining the oral cavity, the tonsils attract attention: they are enlarged, with dirty gray films that are difficult to remove with a spatula. The patient's mouth smells of rot.
• Acute epiglottitis is an inflammation of the epiglottis area. Signs of laryngeal stenosis increase gradually and are characterized by severe inspiratory shortness of breath, dysphagia and general anxiety of the patient. His condition is serious, his body position is forced (sitting), his temperature rises to febrile levels. Examining the oral cavity, you can see the root of the tongue is dark cherry in color. During laryngoscopy - swelling of the epiglottis and epiglottis.
• A retropharyngeal abscess always debuts acutely with an increase in body temperature to febrile levels, increasing shortness of breath with difficulty in inhaling, turning into suffocation, and severe general anxiety. The patient's position is forced - with the head thrown back and to the affected side. Breathing is snoring, difficult especially when the patient is lying down. Salivation increased. When examining the pharynx, there is a noticeable bulging of the posterior wall and a symptom of fluctuation, indicating the presence of inflammatory fluid in the area of ​​examination.
• The presence of a foreign body in the larynx absence of signs of inflammation and intoxication. In case of complete obstruction, the patient cannot take a breath or speak. Points fingers at neck. Inspiratory stridor and paroxysmal cough are noted.
• Obstructive bronchitis is characterized by signs of inflammation in the upper respiratory tract. Those. the patient complains of a runny nose, cough, and hoarseness may be present. Body temperature rises to 37–38 °C, there are signs of moderate intoxication. Noteworthy is the pronounced expiratory shortness of breath, i.e. it is difficult for the patient to exhale. On percussion of the lungs there is a boxy tone of sound, on auscultation there are dry and moist medium- and large-bubble rales over the entire surface of the organ.

Differential diagnosis

Acute epiglottitis is a form of acute laryngitis, often of bacterial etiology, in which the epiglottis is affected. It is characterized by a sudden onset, the body position is with the head thrown back and the mouth open, there is difficulty swallowing, drooling, and fever.

Peritonsillar, parapharyngeal, retropharyngeal abscesses are purulent inflammation in the oropharynx. It is characterized by sore throat on the affected side, nasal sound, difficulty opening the mouth (trismus of mastication), drooling, stiff neck, and fever.

Allergic edema (acute angioedema). Characterized by a rapid onset without preceding symptoms of a cold or fever, swelling of the lips and tongue, rash (urticaria), and dysphagia (difficulty swallowing) are observed.

Symptoms

False croup manifests itself in several stages and its symptoms usually appear at night. Stage one is characterized by the child’s anxiety, the appearance of a rough “barking” cough, shortness of breath and rapid breathing. In this condition, you can help the baby and prevent the progression of the pathology, but it is still advisable to call an ambulance, since you can never predict how the baby’s body will react to therapeutic measures.

The second stage is characterized by the appearance of noisy breathing, increasing shortness of breath and the participation of additional respiratory muscles in the process of inhalation and exhalation. As the attack progresses, the child becomes pale, covered in cold sweat, and signs of anxiety increase. The lips and area around the mouth become bluish, which is the main symptom for parents, indicating that their child is experiencing a lack of oxygen.

If emergency assistance is not provided to the child during this period, more serious symptoms may occur, such as:

• anxiety and fear, turning into apathy and lethargy;
• the appearance of signs of respiratory failure and tissue hypoxia;
• the appearance of hoarseness;
• severe shortness of breath;
• noisy breathing with gradual cessation of cough (due to stenosis of the lumen of the larynx);
• development of cyanosis of the skin and mucous membranes;
• a sharp drop in pressure;
• fainting.

The last, terminal stage is characterized by symptoms such as coma, the development of convulsions, slowing of blood circulation and cardiac arrest.

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