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The management of recurrent croup in children

Published online by Cambridge University Press:  02 April 2013

I Rankin ,
S M Wang ,
A Waters ,
W A Clement  and
H Kubba
I Rankin
Affiliation:
Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Glasgow, Scotland, UK
S M Wang
Affiliation:
Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Glasgow, Scotland, UK
A Waters
Affiliation:
Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Glasgow, Scotland, UK
W A Clement
Affiliation:
Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Glasgow, Scotland, UK
H Kubba*
Affiliation:
Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Glasgow, Scotland, UK
*
Address for correspondence: Mr H Kubba, Department of Paediatric Otolaryngology, The Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, Scotland, UK Fax: +44 (0)141 2010865 E-mail: [email protected]
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Abstract

Objective:

To review the aetiology, investigation, diagnosis, treatment and clinical outcome of children with recurrent croup.

Method:

Retrospective case note review of all children with recurrent croup referred to the otolaryngology service at our hospital from November 2002 to March 2011.

Results:

Ninety children with recurrent croup were identified. Twenty-five children (28 per cent) had anatomical airway abnormalities, of which 16 (18 per cent) demonstrated degrees of subglottic stenosis. Twenty-three children (26 per cent) had positive microlaryngobronchoscopy findings suggestive of reflux. Eleven children were treated for gastroesophageal reflux disease, 10 (91 per cent) of whom responded well to anti-reflux medication (p = 0.006). No cause was identified for 41 (45 per cent) of the children; this was the group most likely to continue having episodes of croup at follow up. One death occurred in this group.

Conclusion:

Airway anomalies are common in children that present with recurrent croup. Laryngobronchoscopy allows identification of the cause of croup and enables a more accurate prognosis. In the current study, laryngobronchoscopy findings that indicated reflux were predictive of benefit from anti-reflux medications, whereas the clinical presentation of reflux was not. Routine measurement of immunoglobulin E and complement proteins did not appear to be helpful.

Keywords

CroupAcquired Subglottic StenosisCongenital Subglottic StenosisGastroesophageal RefluxBronchoscopyLaryngoscopy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 5 , May 2013 , pp. 494 - 500
Copyright
Copyright © JLO (1984) Limited 2013 

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Footnotes

Presented orally at the Annual Summer Meeting of the Scottish Otolaryngological Society, 10 May 2012, Dunblane, Scotland, UK, and at the 11th International Congress of the European Society of Pediatric Otorhinolaryngology (ESPO 2012), 20–23 May 2012, Amsterdam, the Netherlands.

References

1Leung, AK, Kellner, JD, Johnson, DW. Viral croup: a current perspective. J Pediatr Health Care 2004;18:297–301CrossRefGoogle ScholarPubMed
2Griffin, S, Ellis, S, Fitzgerald-Barron, A, Rose, J, Egger, M. Nebulised steroid in the treatment of croup: a systematic review of randomised controlled trials. Br J Gen Pract 2000;50:135–41Google ScholarPubMed
3Denny, FW, Murphy, TF, Clyde, WA Jr, Collier AM, Henderson FW. Croup: an 11-year study in a pediatric practice. Pediatrics 1983;7:871–6CrossRefGoogle Scholar
4Hide, DW, Guyer, BM. Recurrent croup. Arch Dis Child 1985;60:585–6CrossRefGoogle ScholarPubMed
5Farmer, TL, Wohl, DL. Diagnosis of recurrent intermittent airway obstruction (“recurrent croup”) in children. Ann Otol Rhinol Laryngol 2001;110(7 Pt 1):600–5CrossRefGoogle ScholarPubMed
6Konig, P. The relationship between croup and asthma. Ann Allergy 1978;41:227–31Google ScholarPubMed
7Zach, M, Erben, A, Olinsky, A. Croup, recurrent group, allergy, and airways hyper-reactivity. Arch Dis Child 1981;56:336–41CrossRefGoogle ScholarPubMed
8Burton, DM, Pransky, SM, Katz, RM, Kearns, DB, Seid, AB. Pediatric airway manifestations of gastroesophageal reflux. Ann Otol Rhinol Laryngol 1992;101:742–9CrossRefGoogle ScholarPubMed
9Yellon, RF, Coticchia, J, Dixit, S. Esophageal biopsy for the diagnosis of gastroesophageal reflux-associated otolaryngologic problems in children. Am J Med 2000;108(suppl 4a):131–8SCrossRefGoogle ScholarPubMed
10Myer, CM 3rd, O'Connor, DM, Cotton, RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol 1994;103:319–23CrossRefGoogle ScholarPubMed
11Hoa, M, Kingsley, EL, Coticchia, JM. Correlating the clinical course of recurrent croup with endoscopic findings: a retrospective observational study. Ann Otol Rhinol Laryngol 2008;117:464–9CrossRefGoogle ScholarPubMed
12Kwong, K, Hoa, M, Coticchia, JM. Recurrent croup presentation, diagnosis, and management. Am J Otolaryngol 2007;28:401–7CrossRefGoogle ScholarPubMed
13Waki, EY, Madgy, DN, Belenky, WM, Gower, VC. The incidence of gastroesophageal reflux in recurrent croup. Int J Pediatr Otorhinolaryngol 1995;32:223–32CrossRefGoogle ScholarPubMed
14Arslan, Z, Cipe, FE, Ozmen, S, Kondolot, M, Piskin, IE, Yoney, A. Evaluation of allergic sensitization and gastroesophageal reflux disease in children with recurrent croup. Pediatr Int 2009;51:661–5CrossRefGoogle ScholarPubMed
15Cressman, WR, Myer, CM 3rd. Diagnosis and management of croup and epiglottitis. Pediatr Clin North Am 1994;41:265–76CrossRefGoogle ScholarPubMed
16Chun, R, Preciado, DA, Zalzal, GH, Shah, RK. Utility of bronchoscopy for recurrent croup. Ann Otol Rhinol Laryngol 2009;118:495–9CrossRefGoogle ScholarPubMed
17Tan, AK, Manoukian, JJ. Hospitalized croup (bacterial and viral): the role of rigid endoscopy. J Otolaryngol 1992;21:48–53Google ScholarPubMed
18Stroud, RH, Friedman, NR. An update on inflammatory disorders of the pediatric airway: epiglottitis, croup, and tracheitis. Am J Otolaryngol 2001;22:268–75CrossRefGoogle ScholarPubMed
19Baker, SR. Laryngotracheobronchitis–a continuing challenge in child health care. J Otolaryngol 1979;8:494–500Google ScholarPubMed
20Yellon, RF, Goldberg, H. Update on gastroesophageal reflux disease in pediatric airway disorders. Am J Med 2001;111(suppl 8A):78–84SCrossRefGoogle ScholarPubMed
21Wynne, JW, Ramphal, R, Hood, CI. Tracheal mucosal damage after aspiration. A scanning electron microscope study. Am Rev Respir Dis 1981;124:728–32Google ScholarPubMed
22Zach, MS, Schnall, RP, Landau, LI. Upper and lower airway hyperreactivity in recurrent croup. Am Rev Respir Dis 1980;121:979–83Google ScholarPubMed
23Litmanovitch, M, Kivity, S, Soferman, R, Topilsky, M. Relationship between recurrent croup and airway hyperreactivity. Ann Allergy 1990;65:239–41Google ScholarPubMed
24Cohen, B, Dunt, D. Recurrent and non-recurrent croup: an epidemiological study. Aust Paediatr J 1988;24:339–42Google ScholarPubMed
25Contencin, P, Narcy, P. Gastropharyngeal reflux in infants and children. A pharyngeal pH monitoring study. Arch Otolaryngol Head Neck Surg 1992;118:1028–30CrossRefGoogle ScholarPubMed
26Russell, KF, Liang, Y, O'Gorman, K, Johnson, DW, Klassen, TP. Glucocorticoids for croup. Cochrane Database Syst Rev 2011;(1):CD001955CrossRefGoogle ScholarPubMed
27Van Bever, HP, Wieringa, MH, Weyler, JJ, Nelen, VJ, Fortuin, M, Vermeire, PA. Croup and recurrent croup: their association with asthma and allergy. An epidemiological study on 5-8-year-old children. Eur J Pediatr 1999;158:253–7CrossRefGoogle ScholarPubMed