Cough with stridor: what to know

Stridor is different from wheezing, which is commonly a musical sound during breathing out from narrowed lower airways. Stridor may be loudest over the neck and can change with position, crying, or activity. In children, a viral illness may cause swelling near the voice box and a barking cough. A sudden onset after eating, playing, or taking a medicine raises concern for an inhaled object or allergic reaction. Hoarseness, drooling, trouble swallowing, fever, or a muffled voice add useful clues for a clinician.

The sound should not be judged in isolation. A person can have a cough without stridor, while stridor can occur with little coughing. Asthma and Bronchiolitis generally involve different parts of the airway, so an examination helps separate them.

Keep the person upright, quiet, and close to a responsible adult. Avoid making them lie flat if that worsens the noise. Do not place fingers or objects in the mouth, and do not offer food or drink when swallowing is unsafe. Use only a previously prescribed reliever or other treatment according to its instructions. If a possible choking event occurred, follow emergency first-aid guidance and call for help. Observe whether the noise continues when calm and whether the chest or neck is pulling in.

Call emergency services for stridor at rest, severe or worsening breathlessness, pulling in at the ribs or neck, blue or grey lips, faintness, confusion, or inability to speak or swallow. Drooling with a muffled voice, sudden facial swelling, or a rapid change after a food or medicine is also urgent. A new stridor sound should receive prompt medical assessment even if it improves with rest. Do not drive someone who is becoming exhausted or unable to breathe comfortably.

Ask what part of the airway seems affected, what signs mean the noise is becoming dangerous, and whether a prescribed treatment should be kept available. Tell the clinician when the sound started, whether it occurs at rest, any fever or choking possibility, and whether the person can drink. Mention any history of Asthma, Allergic Rhinitis, or repeated airway symptoms.