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Barks and Wheezes

By Scott Hamilton, MD
December 9, 2021
Hamilton Blog Headshot Updated 12.21.21

This week's guest columnists are Carrie Guidry, MD and Stefanie Acosta, MD, Family Practice Residents at Ochsner University Hospital & Clinics.

When I first heard croup, angry seal sounds were coming from my brother in the bottom bunk. I was terrified he was going to die. The magnitude of the sound was incongruent with his three-year size, and the cough was relentless. The scene reminded me of the movie Terms of Endearment, where a child gets a croup attack and begins making terrible honking sounds. The mother rushes him into the bathroom while the husband stands there in ignorance (like I did). She throws the shower on, steam floods the room and the egregious cough stops. 

Like a regular cold, croup starts with a viral infection. These viruses spread by inhaling other kids' coughs and sneezes or touching virus-laden surfaces and then touching the mouth, eyes or nose. But instead of just runny noses and coughs, children with croup get inflammation in their vocal cords and windpipes. When air is being drawn into the lungs, it whistles through that narrowed airway, causing that harsh, high-pitched sound we call stridor. When the kids cough back through that narrowing, they produce that bark that sounds like a seal. Look on the internet to hear this impressive cacophony.

The home remedy for croup, a steamy bathroom, lubricates those inflamed airways. Croup attacks happen most often at night when the air is dry and “sticks” when it's sucked through narrowed windpipes. Taking kids outdoors, where air is moister than indoors, also works. If those things don't help, bring the child to the ER. We have medication to relieve the narrowing. If kids get repeated attacks in a season, that's called spasmodic croup, and preventive asthma medicines can prevent that too.

I was an asthmatic kid, taking a variety of medicines: inhalers, Claritin and Singulair for prevention; and different inhalers and steroid syrups for emergencies. Some days I didn't feel like taking my medicine and would regret it throughout the day—wheezing, breathless and hitting my rescue inhaler around the clock. If I caught a whiff of cigarette smoke, I knew I'd be coughing for days.

Some high-school friends with asthma ran track-and-field. When I asked them how they could do that, they said exercise made their asthma better and even go away. I was suspicious, but after learning enough medical physiology, I realized they were right. I began to exercise, eat healthier and my breathing improved. I weaned down to just having the emergency inhaler handy—and rarely needed that.

Like with croup that we discussed above, asthma is triggered by winter viruses that kids spread to each other. While croup narrows airways in children's windpipes, asthma inflammation hits the lungs. Instead of making inspiratory whistling like in croup, kids with asthma make quieter wheezing on exhalation. With enough inflammation, they can struggle to breathe.

Ideally, kids with asthma should take daily prevention medication, with rescue meds handy for attacks. If asthma “breaks through,” bring them to their doctor or the ER. We have extra medications and oxygen to make them better or can admit them to the hospital if necessary. Again, ideally, kids with asthma should keep their hands washed and faces covered when others around them cough and spread viruses with mucus-laden hands. They shouldn't be exposed to cigarette smoke or cane burning. They should get their yearly flu shot, a COVID vaccine and exercise regularly. Keep those wheezes and barks at bay!

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