Abstract
In about 3% of children, viral infections of the airways that develop in early childhood lead to narrowing of the laryngeal lumen in the subglottic region resulting in symptoms such as hoarseness, abarking cough, stridor, and dyspnea. These infections may eventually cause respiratory failure. The disease is often called acute subglottic laryngitis (ASL). Terms such as pseudocroup, croup syndrome, acute obstructive laryngitis and spasmodic croup are used interchangeably when referencing this disease. Although the differential diagnosis should include other rare diseases such as epiglottitis, diphtheria, fibrinous laryngitis and bacterial tracheobronchitis, the diagnosis of ASL should always be made on the basis of clinical criteria.
Highlights
In approximately 3% of children [1, 2], viral respiratory tract infections that develop in early childhood lead to a narrowing of the larynx and include symptoms such as hoarseness, a ‘barking’ cough, stridor, and sometimes dysp nea
The authors of this document agree that acute subglottic laryngitis is the most precise term to define laryngeal obstruction in the course of viral upper respiratory tract infections
Acute laryngeal obstruction most frequently occurs during the course of a viral respiratory tract infection in young children (~98%) [9]
Summary
In approximately 3% of children [1, 2], viral respiratory tract infections that develop in early childhood lead to a narrowing of the larynx and include symptoms such as hoarseness, a ‘barking’ cough, stridor, and sometimes dysp nea. The possi ble mechanisms that explain the increased risk of asthma in children with a history of acute subglottic laryngitis include a smaller diameter of the airways (both central and peripheral), more frequent atopy, gastroesophageal reflux, bronchial hyperresponsiveness and common CD14 gene polymorphisms [19,20,21,22]. Laryngeal obstruction is observed only in some children with respiratory tract infections, possibly due to anatomic predisposition (smaller airway diameter) or abnormal immune response (excessive inflammatory and edematous reaction) This is confirmed by a number of epidemiological studies including the cohort analysis from Tuscon which showed higher values of inspiratory resi stance in infants who developed later episodes of stridor without wheezing [19]. The main consequence of the inflammatory reaction within the larynx is inspiratory airflow disturbance with varying degrees of severity
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