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Pseudocroup: treatment, symptoms

by Josephine Andrews
Published: Last Updated on 356 views

Croup is an infection of the upper respiratory tract that mainly affects babies and young children. The so-called croup cough is characteristic, a paroxysmal cough that in some cases leads to shortness of breath. Croup usually heals by itself. He rarely needs hospital treatment. Read more about pseudocroup here.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

J38 J20

letter overview

  • Symptoms: Paroxysmal, dry, barking cough; possibly shortness of breath; Fever, hoarseness, wheezing, weakness, general malaise
  • Causes and risk factors : Cause mostly different cold viruses, very rarely bacteria; Favorable factors: cold winter air, air pollution, cigarette smoke, existing allergies
  • Diagnosis: Based on the symptoms, medical history, physical examination (including a throat examination), rarely a blood test or throat swab, rarely an X- ray
  • Treatment: cortisone suppositories, antipyretics; in case of severe shortness of breath, treatment in the hospital (with cortisone, adrenaline , possibly oxygen supply)
  • Prognosis: Usually heals on its own within a few days; very rarely complications such as pneumonia, otitis media
  • Prevention: Prevention of colds in general; if you have a cold, ensure there is sufficient humidity, avoid tobacco smoke; Vaccination against some of the causes such as measles, chickenpox, influenza possible

What is pseudocroup?

Pseudocroup (croup cough) is an acute infection of the voice box (larynx) above the glottis (glottis) and the windpipe (trachea). It is usually caused by various cold viruses . The germs attack the upper respiratory tract, causing the mucous membranes in the throat, nose and throat to swell considerably and narrow the airways. In addition, there are muscle cramps (spasms) in the lower larynx and upper trachea.

All of this leads to the main symptom of pseudo-croup: the paroxysmal, dry, barking cough . It may be accompanied by other symptoms, such as shortness of breath, hoarseness, fever, runny nose and general malaise.

Most pseudo-croup diseases occur in the autumn and winter months . Children between the ages of one and five are usually affected – boys a little more often than girls. Most children will get croup once or twice in their lifetime. Occasionally, pseudocroup occurs more frequently in children or even beyond the typical age period. Often these are children who are prone to asthma.

Croup in adults is very rare.

Pseudocroup: This is how the barking cough develops
In pseudocroup, the mucous membranes of the upper airways swell and become inflamed. This causes the typical cough, hoarseness and runny nose.

Physicians also refer to pseudocroup as stenosing laryngotracheitis, subglottic laryngitis or laryngotracheobronchitis.

Pseudo-Krupp is not the same as Krupp

Pseudokrupp and Krupp are not the same. The “real” croup is a potentially life-threatening laryngitis in the context of diphtheria disease. However, thanks to nationwide vaccinations, this infection has become so rare that the term “croup” is colloquially used as a synonym for pseudocroup. Croup syndrome has also become a synonym for pseudocroup.

What is a pseudocroup attack like?

In some cases, a pseudo-croup attack occurs suddenly and can be very violent. The dry, barking, paroxysmal cough often occurs in the middle of the night. An attack is favored by dry (heating) air and breathing through the mouth, which is often observed in children with respiratory infections. Both cause the mucous membranes to swell further. The risk of a pseudo-croup attack is also particularly high at night when the body produces less anti-inflammatory cortisol .

Is croup contagious?

Pseudocroup is usually caused by various cold viruses. When coughing, speaking and sneezing, patients spread tiny droplets of saliva in the area that are infected with the triggering virus . Other people may inhale these infectious droplets of saliva and may then become ill themselves ( droplet infection ).

Infection is also possible if a healthy person uses glasses, cutlery, handkerchiefs, etc. that are infected with the infectious saliva of a patient.

In this respect, the infection is usually contagious – but usually only as a “normal” cold. Anyone who becomes infected does not necessarily have to develop the symptoms of pseudocroup such as croup cough, but may only suffer a cold with the corresponding different symptoms.

Pay more attention to hygiene with pseudocroup and keep your sick child away from other children if possible. For example, do not send it to kindergarten until it has recovered.

symptoms

The classic symptom of pseudocroup is a dry, barking cough ( croup cough ), which usually occurs at night . This nocturnal accumulation is probably due to the fact that the cortisol level in the body falls to its lowest point between midnight and 4 am The effect of the anti-inflammatory hormone is therefore at its lowest in this phase.

Many children with pseudocroup also suffer from acute shortness of breath at night. However, the shortness of breath may also slowly increase during the day. In the case of very severe shortness of breath, the body is no longer sufficiently supplied with oxygen. This can be recognized, for example, by the fact that the pulse accelerates (palpitations) and the affected person breathes quickly and labored (with a clear rise and fall of the chest and flared nostrils).

It is also possible that small pits (indentations) form in the spaces between the ribs. With increasing lack of oxygen, fingertips and lips turn blue (cyanosis). Those affected feel fear and restlessness, which intensifies the acute symptoms.

The pseudo-croup symptoms are similar to those of epiglottitis. The latter often becomes life-threatening very quickly. You should therefore consult a doctor immediately at the first sign of shortness of breath in you or your child.

Other symptoms of pseudocroup include:

  • fever
  • hoarseness
  • Difficulty inhaling with wheezing or “squeaking” sounds (inspiratory stridor)
  • General malaise
  • weakness

Since pseudo-croup usually develops as a result of a cold, the symptoms of pseudo-croup also include a runny nose and a normal cough in the early stages of infection.

Pseudocroup in adults

Adults suffer significantly less from the mentioned pseudocroup symptoms than children. Shortness of breath and bluish discoloration of the skin and mucous membranes (cyanosis) hardly ever occur. However, dry, barking croup cough with particularly severe attacks at night as well as hoarseness and fatigue are also typical in adult patients.

pseudocroup stages

Based on the symptoms, pseudocroup can be divided into four degrees of severity (stages):

  • 1st stage: Typical barking pseudocroup cough, hoarse voice
  • 2nd stage: breathing sounds when inhaling, contraction of the chest when inhaling
  • 3rd stage: Shortness of breath, increased heart rate, anxiety, pale complexion
  • 4th stage: Severe shortness of breath, flat and rapid pulse, breathing noises when breathing in and out, blue discoloration of the skin, disturbances of consciousness

Causes and risk factors

Pseudocroup is usually triggered by cold viruses. This includes:

  • parainfluenza viruses
  • Influenza viruses (type A or B)
  • RS, rhino, adeno and metapneumo viruses

More rarely, measles, chickenpox, herpes simplex and Epstein-Barr viruses are responsible for the disease.

As a result of the viral infection of the mucous membranes in the mouth, nose and throat, the vocal cords below the voice box (larynx) swell. It is also possible that increased mucus accumulates in the bronchi. This causes symptoms such as hoarseness and shortness of breath.

In babies and small children, the airways are still very narrow. Therefore, under certain circumstances, even a small additional narrowing can be life-threatening. Therefore, if you suspect pseudocroup, consult your doctor or pediatrician immediately.

The pseudo-croup symptoms are often aggravated by various factors. These include air pollution and cigarette smoke. Existing allergies also have a beneficial effect.

Sometimes croup is caused by bacteria . In some cases, for example, an infection with the bacterium Staphylococcus aureus or with pneumococci causes pseudocroup. Allergies can also cause the typical barking croup cough. One then speaks of spastic croup cough .

investigations and diagnosis

A doctor usually recognizes pseudocroup based on the typical cough and the whistling noises when inhaling. In addition, he asks more precisely about the symptoms in order to collect the medical history (anamnesis). Possible questions are:

  • How long has the cough been there?
  • How often does the coughing fit to occur?
  • Are there other symptoms?
  • Is there shortness of breath?

The doctor then determines the severity of the disease using a point system (Westley score): the symptoms of breathing noises (stridor), retractions of the skin, shortness of breath, blue coloring of the skin and mucous membranes (cyanosis) and impairment of consciousness are taken into account. In total, this results in a mild, moderate or severe pseudocroup . The severe form is characterized by acute shortness of breath that requires hospital treatment. But it is seldom.

Finally, it is still necessary to differentiate the possible pseudocroup from an inflammation of the epiglottis (epiglottitis). This disease shows symptoms similar to pseudo-croup, but is often life-threatening. To clarify, the doctor examines the patient’s throat: the tongue is pressed down with a small spatula so that the doctor has a clear view. The examination does not take long and is painless.

Very rarely it is necessary to take a blood sample or a throat swab and examine it in a laboratory for a bacterial infection.

An X-ray of the chest ( X-ray thorax ) is usually not necessary, but it helps if the diagnosis is unclear.

treatment

Pseudocroup is usually rather mild and can be treated at home. It is advisable to sleep with the window open if possible. Factors that promote a pseudo-croup attack should be avoided (eg tobacco smoke in the air). Cortisone suppositories help against the inflamed, swollen mucous membranes of the respiratory tract . They prevent shortness of breath. If necessary, an antipyretic drug with paracetamol or ibuprofen is also given .

If the doctor has diagnosed moderate or severe pseudocroup, children in particular are generally treated in the hospital . In emergencies (severe acute shortness of breath), professional help is quickly available. Adults usually only get mild pseudocroup, which is why they are rarely treated in hospital.

Drugs with epinephrine, adrenaline and cortisone are used in the pseudo-croup treatment in the hospital. The active ingredients allow the mucous membranes to decongest. In the case of severe shortness of breath with acute lack of oxygen, oxygen is supplied via a breathing mask or – in extremely rare cases – after a tracheotomy via a small tube ( intubation ). If necessary, those affected are also given a sedative during an acute attack.

First aid for a pseudo-croup attack

Cold causes the airways to decongest and the attack to subside. Therefore, you or your child should do the following in the event of an acute attack of croup:

  • Breathe in cool air, at the open window or outside on the balcony or in the garden
  • Raise the victim’s upper body
  • Take cool drinks (in small sips, water or tea, no milk)
  • Calm down yourself or your child, because anxiety makes symptoms worse.

In the case of mild pseudocroup, these measures are often sufficient to end an attack.

In the case of a severe pseudocroup attack, the typical coughing attack is accompanied by signs of a lack of oxygen (pale skin, bluish lips, shortness of breath, tachycardia, anxiety, etc.). Then call the emergency doctor immediately!

For a long time, the recommendation was to allow moist air to be breathed in during an acute pseudocroup attack (air humidification, for example, with the help of nebulizers, air humidifiers or damp towels). However, it has not been scientifically proven that this helps.

home remedies

In mild cases, the symptoms of pseudo-croup can often be alleviated with home remedies. These include chamomile blossoms and Emser salt, which can be used very easily by means of steam inhalation (pour hot water over a bowl, the person concerned inhales over the bowl, possibly with a towel over their head). The active ingredients are said to have a calming and anti-inflammatory effect.

Lavender oil breast wraps or teas made from mallow, lavender and valerian are other proven home remedies for the supportive treatment of pseudo-croup.

Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.

homeopathy

Some parenting guides recommend treating croup with homeopathic remedies. The drugs of choice are Aconitum napellus in the initial phase, Spongia tosta for the night andHepar Sulfuris in the morning to prevent another attack, as well as Aconitum or Belladonna .

However, the effectiveness of homeopathic remedies has not been scientifically proven.

Presumably these substances do no harm either. They may be able to help keep calm during a pseudo-croup attack. If the course is mild, this is often enough to get the acute symptoms under control.

Course of the disease and prognosis

Most cases of pseudo-croup belong to the first stage and heal easily on their own. Complications such as inflammation of the middle ear (otitis media) or pneumonia develop only very rarely.

duration

Croup generally lasts between two days and two weeks, depending on the general health of the sufferer. Rarely, pseudocroup attacks occur repeatedly over a longer period of time .

prevention

The measures with which one generally tries to prevent a cold are considered to prevent pseudocroup. So healthy, varied diet, weather-appropriate clothing, avoiding crowds during the cold season (or wearing a mask in local public transport and other places).

If your child suffers from a cold (flu-like infection), avoid possible factors that favor pseudocroup. Make sure there is sufficient humidity (especially in the heating season), and if possible do not expose the child to tobacco smoke. Paediatricians generally recommend not smoking in the home if children are there regularly. Passive smoking generally increases the risk of children suffering from pseudocroup.

There is no vaccination against pseudo-croup because of the many different causes. There are also no vaccinations available against most cold viruses. However, some causes such as measles, chickenpox or influenza viruses can be effectively avoided with vaccinations.

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