Asthma and croup together

Croup usually causes swelling around the voice box and upper airway, producing a barking cough, hoarse voice and a harsh sound when breathing in. Asthma affects the lower airways and may produce wheeze, chest tightness, cough and difficulty breathing out. A viral illness that causes croup may also trigger asthma symptoms in a child who has asthma.

Stridor is a high-pitched or harsh noise heard mainly as the child breathes in and points to narrowing in the upper airway. Wheeze is a musical sound often heard during breathing out and can accompany asthma. The sounds can be difficult to distinguish, especially when a child is upset, and either condition can cause visible effort. Treatment for one does not automatically treat the other, so do not simply repeat asthma medicine for persistent stridor.

Keep the child upright and calm because crying can make noisy breathing more noticeable. Offer fluids in small, comfortable amounts and check them frequently, including during the night. Follow the child's asthma action plan for familiar lower-airway symptoms and use prescribed inhalers with the recommended spacer. Arrange prompt medical advice for suspected croup because a clinician may recommend medicine that reduces upper-airway swelling. Avoid steam inhalation, which can cause burns and has no dependable role in treating croup.

Call emergency services if the child struggles for breath, has stridor while calm, shows pulling in around the ribs or neck, develops blue or grey lips, drools or cannot swallow, becomes unusually sleepy or difficult to wake, seems limp, or is too breathless to drink or speak. Emergency help is also needed if asthma reliever medicine is not working according to the action plan. Do not examine the throat or force a distressed child to lie down.

Describe whether the noise occurs while breathing in or out, whether it continues at rest, and how the child is drinking, speaking and responding. Ask which symptoms should be treated through the asthma plan, whether the croup needs specific medicine, and when the child should be reviewed again. Bring the inhaler, spacer and written action plan if attending in person.