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Name that Bark: Croup or Cough Variant Asthma?

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Fall is a time of warm colors, crisp smells, and distinctive sounds – the crunch of leaves, the brewing of cider… the seal-like barking of small children.

Children barking? That’s right – parents with growing kids know all too well the unsettling calling card of croup.

Croup – only moderately different from “crap,” which is what kids feel like when they have it – is caused by several different viruses and classically manifests with tracheobronchitis, or an inflammation of the larynx – the voice box and vocal chords – and occasionally even affects the bronchi, which lead to the lungs.

In younger children, the inflammation classically results in a barking or seal-like cough, due to a child’s smaller airway. When even a small portion of that airway becomes swollen, significant constriction ensues, causing turbulent airflow – and that horrible cough. (To contrast, in an adult, air generally passes without turbulence, though an older individual may suffer from laryngitis – or a dampening of the sound produced by the vocal chords.)

Cases of croup often develop suddenly and can range from mild to severe, causing significant airway obstruction. Most episodes can be treated with steroids, others with specific respiratory inhalers, such as Racemic epinephrine.

There exists, however, a separate condition that shares the same underlying cause – inflammation – with croup, but is actually a distinctive in its own right.

Cough variant asthma (CVA) is a somewhat less common form of asthma made distinguishable by its main symptom – a dry, hacking cough. This trait can prove difficult for parents to differentiate from croup. Wheezing may or may not be present in either case, making recurrence the primary means of telling the two apart. Children who have CVA often have frequent episodes of croup, which are ultimately revealed to be a symptom of the illness. CVA is a lower respiratory condition, as opposed to croup’s upper airway inflammation, and will often progress into full-blown asthma later in a child’s life.

Interestingly, CVA is also associated with other atopic conditions, such as eczema or seasonal allergies, which may be present in the child or members of the child’s family.

If your child develops a barking cough this season, it is best to seek a pediatrician’s advice. Whatever the case may be – croup or cough-variant asthma – he or she should be able to provide relief, both for the patient and your ears.

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