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Column originally published Jul 25, 2023

Recurrent Croupy Cough Can Be A Form Of Asthma

Question: We are still in the middle of summer, and I am already dreading about coming fall and winter. Our 10-year-old son has croup every time when he gets a cold, since he was very young. It almost always started with cold-like symptoms, with fever, running nose, and before we know it, he would wake up with a bad croupy cough and difficulty breathing. We have taken many trips to the emergency room. He has been given puffers, masks, and sometimes steroids by mouth. When the croupy cough breaks, he would have congested cough for many days, and sometimes we can hear him wheeze. Some doctors have suggested that he may have virus-induced asthma. I thought asthma is a more persistent condition rather than caused by virus. When he runs, he doesn’t get out of breath unless when he is sick and coughing.


I think the doctors that have seen him may be right, he can have virus-induced asthma as the reason for his recurrent episodes of croup whenever he gets a cold.

For some people, they have signs and symptoms of asthma almost every day. When they run, they cough and get out of breath, while others around them may hear wheezing sound when they breathe. This can be on a daily basis, and they almost always get worse when they get sick with a cold. These are the ones who have the severe and persistent form of asthma.

For most individuals, they have milder form of asthma that they are not even aware of. When they are healthy, the can run without much difficulty, unless if they run very fast, or for a long time. Then, they can get out of breath and may cough. They often have few symptoms until they get sick, or if they are exposed to things that they are allergic to.

When they catch a virus, like the common-cold virus, or influenza virus, they can get quite sick with cough, much sicker than most average individuals.

In children, their cough can become quite croupy, with a barking sound. This is likely because children have smaller airways compared with adults. The virus infection causes swelling of the mucus membranes, further narrowing their airways and produce this barking cough that can be quite terrifying. They often have difficulty breathing as well, sucking in between their ribs and under the ribcage, as well as flaring of their nostrils. Their oxygen saturation can be decreased when they are examined at the emergency room. This respiratory distress can become an emergency very quickly.

Over the last few decades, many treatments have been tried to help these children with respiratory distress and croupy cough. If their oxygen level is low, they are given oxygen by mask or through a tubing with little prongs inside their nose. The most effective treatment is steroid. This may reduce inflammation and swelling in their airways, allowing oxygen to go into their lungs and reduce respiratory distress. As a result, their cough will become more loose and less croupy.

Other medications like bronchodilator (for example, salbutamol, also called ventolin) that can reduce airway narrowing, as well as inhaled steroid, have less obvious benefit when the cough is tight and croupy. However, once the worst part of croup has improved, inhaled bronchodilator and steroid can expedite recovery.

Fortunately, as children get older, it is less likely for them to have tight croupy cough when they get sick. Their cough can improve with inhaled bronchodilator and steroid. If they have the puffer form of inhalers, they will need to use a chamber to improve delivery of the medicine into their lungs. The powder form of inhalers don’t require a chamber and are easier to use.

Some children with recurrent croupy cough following virus infection can develop more obvious symptoms of asthma, with congestion, cough, and wheeze even in between colds. Lung function test can be done in those children who can cooperate and take deep breaths following instruction. I have done it many times; I have to say, it is not easy.

I would suggest that you monitor him for cough and congestion, and consult with your doctor if needed.