From the Guidelines
Recurrent episodes suggest the diagnosis of spasmodic croup. The clinical presentation of spasmodic croup is characterized by recurrent episodes of respiratory distress that resolve spontaneously, often within hours, and tend to recur 1. Unlike viral croup, spasmodic croup lacks the gradual development of symptoms over 1-2 days and the associated fever and rhinorrhea. Children with spasmodic croup typically appear well between episodes, and symptoms dramatically improve with exposure to cool air or mist. The condition often has a strong family history component and may be associated with allergic or reflux triggers.
Some key features of spasmodic croup include:
- Recurrent episodes of barking cough and stridor that typically occur at night
- Absence of preceding upper respiratory symptoms or fever
- Spontaneous resolution of symptoms within hours
- Dramatic improvement with exposure to cool air or mist
- Strong family history component
- Possible association with allergic or reflux triggers
It's worth noting that the provided evidence 1 primarily discusses infantile hemangioma, which can cause symptoms similar to croup, but the key distinguishing feature of spasmodic croup is its recurrent and episodic nature. Management of spasmodic croup includes humidified air, oral dexamethasone, and in severe cases, nebulized epinephrine. The episodic nature and dramatic response to environmental changes help distinguish spasmodic croup from other causes of upper airway obstruction.
From the Research
Clinical Features of Spasmodic Croup
The clinical features that suggest the diagnosis of spasmodic croup include:
- Recurrent episodes: Spasmodic croup is characterized by recurrent episodes of croup, as stated in the study 2.
- Absence of viral prodrome: Spasmodic croup can occur suddenly without a viral prodrome, as mentioned in the study 2.
- No high fever: The study 3 states that many patients experience low-grade fevers, but fever is not necessary for diagnosis, and high fever is not typically associated with spasmodic croup.
- No seasonality: There is no mention of seasonality being a characteristic of spasmodic croup in the provided studies.
Differentiation from Other Types of Croup
It is essential to differentiate spasmodic croup from other types of croup, such as viral croup, which typically presents with a viral prodrome and may have a seasonal pattern. The study 4 compared the efficacy of corticosteroid treatment in laryngotracheitis and spasmodic croup, highlighting the importance of distinguishing between these two conditions.
Treatment and Management
The treatment and management of spasmodic croup may involve the use of corticosteroids, such as dexamethasone, as stated in the studies 5 and 4. Nebulized epinephrine may also be effective in reducing symptoms, as mentioned in the study 5. However, the diagnosis and management of spasmodic croup should be guided by the clinical presentation and medical history of the patient.