Dealing with Croup Cough

Have you ever had to endure symptoms such as a barking cough, fever, and difficult breathing? Or do your kids or loved ones currently experience these symptoms? If yes, then you may have suffered, or your loved ones are suffering from a croup cough without knowing it. But sit back and relax as we take you through the tidbits as well as the deepest details about this condition.

What`s Croup Cough?

A croup cough is a key symptom of croup, which is a viral disease of the respiratory system. Croup, medically referred to as laryngotracheobronchitis, is a respiratory infection which is caused by the presence and actions of a number of viruses. The infection caused by the activities of these viruses leads to the swelling of the walls of the inner trachea, which poses a great hindrance to breathing normally.

While a croup cough affects teenagers too, its symptoms and effects are more pronounced in children below the age of three. It is a relatively common infection that 15% of children in the United States suffer from every year, with children between five months and five years being the most susceptible to the infection. It is found sometimes (albeit rarely) among teenagers up to 15 years of age and is more predominant among males than females. It is most likely to occur in autumn.

Historically, croup frequently occurred as an offshoot of diphtheria and was extremely fatal but today, due to the development and success of the diphtheria vaccine, this cause has become extremely rare in developed countries.

Its Causes

Usually, croup cough is a condition that arises from a viral infection. In advanced medical settings, the term is used to describe other diseases such as a spasmodic cough, acute laryngotracheitis, bacterial tracheitis, laryngotracheobronchitis, laryngeal diphtheria, and laryngotracheobronchopneumonitis. So many terms to deal with Some of these conditions are caused by viruses and are normally mild, while others are bacterial diseases, and are more severe.

Viral croup cough, divided into acute laryngotracheitis and spasmodic croup types 1 and 2, is caused by the parainfluenza virus in about 75% of all cases. Other viral causes such as influenza A and B, adenovirus, and respiratory syncytial virus (RSV) are responsible for the other 25% of all cases.

Bacterial croup, on the other hand, is divided into laryngeal diphtheria, laryngotracheobronchitis, bacterial tracheitis and laryngotracheobronchopneumonitis (LTBP). All four conditions have different bacterial causes, quite unlike their viral counterparts. While laryngeal diphtheria is caused by Corynebacterium diphtheriae, bacterial tracheitis, laryngotracheobronchitis, and LTBP are caused by Staphylococcus aureus, Streptococcus pneumoniae, and Hemophilus influenzae respectively. 

Pathophysiologically, croup is caused by the inflammation of respiratory structures such as the larynx, trachea, and bronchi, which is caused by the infiltration of the leucocytes, most especially the lymphocytes, neutrophils, and plasma cells. This swelling leads to obstruction of the airway, which then leads to difficulty breathing and stridor, which is characterized by a noisy flow of air.

Signs and Symptoms

A croup cough is usually betrayed by a “barking” cough, stridor, difficult breathing, which worsens at night. The “barking” cough, which is the chief symptom, resembles the call of a seal. With agitation, the stridor worsens. Critical narrowing of the airways is indicated by audibility of the stridor at rest and in quiet places.

Other symptoms include coryza (which are symptoms associated with common cold), fever, Hoover’s sign, which is a drawing-in of the chest wall, and drooling—which may also indicate the presence of some other conditions.


A croup cough is usually diagnosed using its signs and symptoms. First, an X-ray test of the neck is carried out, which may show the trachea narrowing. This is called the “steeple sign”, due to subglottic stenosis which is steeple-like. The steeple sign is only suggestive of the condition and, in fact, could be absent in half of the cases. In research settings, viral cultures could be obtained by nasopharyngeal expiration so as to determine the exact causative organism.

For determining the severity of croup, a commonly used system is the Westley Score. However, it was designed (and is used) more for research than it is for clinical practice. It is the cumulation of scores allotted for five factors: cyanosis, stridor, air entry, and retractions. For a score of less than or equal to 2, there is an indication of mild croup cough; that is, barking cough is present, but stridor is not audible at rest. A score of 3 to 5 indicates moderate croup cough and with it comes the signs of mild croup cough but audible stridor begins at this stage. Any score between 6 and 11 is regarded as severe croup cough; at this stage, drawing-in of the chest wall begins, as well as very audible stridor at rest. A total score of twelve or greater is a pointer to looming respiratory system failure.

Most children (about 85%) presented to the emergency units suffer from the disease mild stage. In fact, less than 1% of children who suffer from a croup cough suffer from severe croup cough.

Preventing Croup Cough

As mentioned earlier, the croup cough was regarded as a diphtherial disease, but today, with vaccination, diphtheria is now rare in the Western world. However, the other condition associated with a croup cough, influenza, remains quite common and so the general way in which a croup cough is prevented is by vaccination against influenza.

Another way by which a croup cough could be prevented is by deliberate health measures against the earlier-mentioned bacteria and viruses.


female doctor


Treatment, especially in children, usually begins by ensuring that such children are kept as calm as possible. Steroids are normally administered, with epinephrine, the most used steroid in severe cases after the patient must have been hospitalized for proper observation. Blow-by administration of oxygen, which involves holding a source of oxygen near the patient’s face is employed when oxygen is needed, to prevent agitation that arises from the use of an oxygen mask.

The use of corticosteroids such as dexamethasone has been proven to speed up recovery among children with all stages of a croup cough. With the use of these drugs, appreciable relief is usually noticed as quickly as three to four hours after administration especially if they are administered orally, through intravenous infusions, and by inhalation. Just one dose is sufficient for therapy and safe too. For dexamethasone, doses of 0.15, 0.3, and 0.6 mg/kg are very effective for treatment.

Severe coughs could also be treated using nebulized epinephrine which is used to induce reduced severity of the cough. Epinephrine typically gets to work within 10 to 30 minutes, while improvements last for two hours. In cases where improvements last more than four hours, the child is normally discharged from hospital and treated till total cure at home.

Studies have revealed other forms of treatment of a croup cough, but no sufficient evidence has been tendered by researchers to support their use worldwide. Traditionally, the inhalation of steam or air in humidified form is used to treat croup cough, but clinically, there has been little evidence to substantiate its effectiveness; breathing in a mixture of helium and oxygen have been adopted in some cases to ease breathing, especially in severe cases. Due to the viral nature of the organisms that cause croup cough, antibiotics are not usually used, except there is suspicion of a secondary bacterial infection, in which case antibiotics containing vancomycin and cefotaxime should be used for treatment. The use of cough medicines, especially those containing dextromethorphan and/or guaifenesin, are discouraged.

Final Words…

The state of your health, along with those of your loved ones, is of paramount importance. If you’ve got children below the age of six, ensure to regularly check them for symptoms of croup cough, and see a doctor for comprehensive guidelines to tackle croup if suspected and/or diagnosed. Stay healthy!