Recurrent Croup: Diagnostic and Treatment Dilemmas

PROGRAM DESCRIPTION: Croup or larynotracheobronchitis, refers to upper or central airway obstruction/resistance secondary to inflammation and edema of the larynx, subglottis, trachea or bronchi. RC is a common problem in the pediatric population. Prior to the COVID pandemic, the incidence of RC was 6.4% within the first 4 years of life, however the incidence, severity and duration of symptoms associated with RC as increased since the COVID pandemic, specifically the Omicron variant. RC is defined as two or more episodes of a bark-like cough, hoarseness, stridor +/- respiratory distress. RC is frequently associated other viral symptoms (viral croup) but can also occur with non-infectious triggers (spasmodic croup). RC is a symptom of an underlying inflammatory, anatomic and/or occasionally a neuropsychiatric process. Studies have found associations between RC and other upper and lower aerodigestive diseases, such as asthma, gastroesophageal disorders, subglottic stenosis, and laryngotracheomalacia . Treatment depends on the underlying condition. However, despite various diagnostic interventions and multi-specialty evaluation, up to 45% of children may have no identifiable cause for their RC, making a treatment plan for these patients challenging.

This panel is a case-based discussion of the work up and management of RC in children. The audience will obtain great working knowledge of the etiologies associated with RC, work up diagnostic instruments used to differentiate etiologies and treatment options available. The panelists will discuss their multidisciplinary approaches to work up and management of RC.