February 3rd 2015 - Croup & Asthma

February 3rd 2015 - Croup & Asthma

NOT a good combination!  However, this isn't the 1st time its happened so we are aware of signs, symptoms and ways to treat etc.

HISTORY - My middle son is now 9years old, he has suffered with croup since he was a baby and has been treated as asthmatic since he was 18months old and had his first "asthma attack" when walking up to Edinburgh Castle in Scotland, he didn't want to go in his pushchair but walk like his brother.  He got part way and started to slow down, we thought he was just trired, but then he started to cough and then wheeze as he breathed.  Having had asthma since I was 7 I always have an inhaler with me, and I used it on my son.  It stopped the wheeze and eased the cough. 

When we got back to where we were staying we rang the local doctors and explained that we were on holiday and what had happened with my son.  The doctors agreed to see us but told us to take him to the park and let him run about for half an hour before his appointment.  We did this and he started coughing again.   Well at his appointment the doctor said "I think he has early onset of asthma."  And with that we left with a prescription for a spacer and inhaler.

As I put above he has suffered with croup since he was a baby, the first time he had it was very scary, the cough that sounds like a dog or seal barking and the husky cry gets you out of bed very quickly and is a sound you don't forget.  I thought it was whooping cough, so off to out of hours doctors we went to be told it's croup.  They told me the signs & symtoms to look out for and simple ways I could try and treat it at home.  All good.  The same with his asthma, just before 2years he had another asthma attack from running around outside, his inhaler didn't work and I had to call an ambulance to him, again a very scary process, the crew were brilliant and hooked him to nebuliser straight away but he didn't want the cute teddy mask on his face!  I had to hold him and the mask to his face as he wriggled all the way to the hospital.  Anyway, we got sorted and were told of what to keep an eye out for.  So he gets croup and now throw his asthma attacks into the equation as well = a very stressful time.

Both croup and asthma cause the walls of the upper airway and windpipe to swell and inflame causing it hard to breathe and talk and swallow.  Most people just suffer with one or the other, but my son has to be different and suffer from both!!!  This means that nearly every time he gets croup he has an asthma attack shortly afterwards or at the same time.

NOW - as I put above he is now 9years old and according to most sites on the internet croup is suffered from those under the age of 5years.  But as the doctor said yesterday he is ticking all the boxes for croup despite his age.  This is what was said over 6months ago when he got it as well.  They have no idea how come he is still getting it or if it is just coming across as croup but is his asthma.  He doesn't wheeze very often with his asthma but gets a cough and even when he has an attack (not very often now thankfully) he coughs when struggling to breathe.  Coughs linked to asthma are not very common but they do exist.  His asthma attacks are usually triggered by a change in temperature - hot to cold, dry to wet and vice versa, he can also have asthma attacks if I change the washing powder!

On the 1st of February I had to take my youngest to the out of hours doctors as he was crying with pain in his ear, as I don't drive this meant we all had to go (parking is terrible at out of hours) so hubby stayed in the car with the older 2 boys.  This is where I think my middle sons problem started as they were sat in a car in the cold for about 20minutes (yes the heater was on but there was snow outside and temp was 1C.  When we got home he started to cough so I made him take his inhalers and thought nothing more of it.  He coughed a few times during the night but seemed ok to go to school on the 2nd.  When he came home on the 2nd his vouce was husky and he was no longer coughing but barking like a dog/seal and said that he had had to use his inhaler a few times at school and his chest hurt when he coughed.  I rang the doctors and they said they had no appointments (I didn't think they would at 4:15pm), but I asked for a doctor to ring me as had an asthmatic son that has a croupy cough and is struggling to breathe - not bad enough for an ambulance yet!  Well the receptionist came back and said 5:30pm appointment they had squeezed us in.

Quickly rush to do tea before we head to doctors.  The doctors were running half hour late by the time we got seen.  Before the doctor even asked what was wrong son was "barking" again and the doctor said sound like he has croup.  So it went from there, he had a temperature, a barking cough, his voice was husky when he spoke and noisy breathing (pretty much all on todays pin).  Doctor initally said to put him in a steamy room and see how he goes - I said he is asthmatic and usually goes downhill quickly with crop and asthma linked and would probably end up in a&e by morning.  The doc hadn't read all his notes but had a quick look through and saw what inhalers son is on and said he would issue prednisolone (steroids) and antibiotics to help me sooner rather than later.

Poor thing was awake most of the night with his barking cough, despite being propped up on pillows in bed.  This does mean that he hasn't gone to school today, and he's still barking away upstairs.  But he has had his second lot of steroids and his second lot of antibiotics so hopefully they will get into his system and start to work soon.

After all of this I will get to the medical bits.

What is croup?
Croup is is a condition that causes an inflammation of the upper airways — the voice box (larynx) and windpipe (trachea). It often leads to a barking cough or hoarseness, especially when a child cries. 

Most cases of croup are caused by viruses, usually parainfluenza virus and sometimes adenovirus or respiratory syncytial virus (RSV). Viral croup is most common — and symptoms are most severe — in children 6 months to 3 years old, but can affect older kids too. Some children are more prone to developing croup when they get a viral upper respiratory infection.
Most cases of viral croup are mild and can be treated at home. Rarely, croup can be severe and even life threatening.  The term spasmodic croup refers to a type of croup that develops quickly and may happen in a child with a mild cold. The barking cough usually begins at night and is not accompanied by fever. Spasmodic croup has a tendency to come back again (recur).  Treatment of symptoms is the same for either form of croup.

Signs and symptoms of croup
May have cold symptoms, like a stuffy or runny nose and a fever. As the upper airway (the lining of the windpipe and the voice box) becomes more inflamed and swollen, the child may become hoarse, with a harsh, barking cough. This loud cough, which is characteristic of croup, often sounds like the barking of a seal. 

If the upper airway continues to swell, it becomes even more difficult for a child to breathe, and you may hear a high-pitched or squeaking noise during inhalation (called stridor). A child also might breathe very fast or have retractions (when the skin between the ribs pulls in during breathing). In the most serious cases, a child may appear pale or have a bluish color around the mouth due to a lack of oxygen.  Symptoms of croup are often worse at night and when children are upset or crying.

Treatment of croup
Breathing in moist air helps and ibuprofen or acetaminophen (only in children over 6 months old) can make them more comfortable. As with most illnesses, rest and plenty of fluids are recommended.
The best way to expose your child to moist air is to use a cool-mist humidifier or run a hot shower to create a steam-filled bathroom where you can sit with your child for 10 minutes. Breathing in the mist will sometimes stop a child from severe coughing. In the cooler months, taking your child outside for a few minutes to breath in the cool air can ease symptoms. if the croup appears serious or there is a suspicion of airway blockage. Doctors often treat croup with steroids to decrease airway swelling. For severe cases, doctors will give a breathing treatment that contains epinephrine (adrenalin).

If you think your child has croup try the home remedies of steam and/or humidifier before going to the doctors, but if you are concerned ring your doctor.