How is acute laryngitis (false croup) treated?

Treatment of acute laryngitis (false croup) is aimed at preventing laryngeal stenosis and, if it occurs, at restoring laryngeal patency.

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Indications for consultation with other specialists

In case of acute stenosing laryngitis at any stage, the child should be consulted by an otolaryngologist; a child with stenosing laryngitis stage III should also be consulted by a resuscitator.

Indications for hospitalization

In case of acute laryngitis and laryngotracheitis without laryngeal stenosis, hospitalization is not required.

In case of stenosing laryngitis in the compensation or subcompensation stage, children should be hospitalized, preferably in specialized boxed departments of a children's hospital, focused on the treatment of children with stenosing laryngitis and having in their arsenal, in addition to a set of medications and ultrasonic inhalers, trained medical personnel, otolaryngologists and resuscitators. Patients with acute stenosing laryngitis, regardless of age, are important to hospitalize together with their mother (the "in mother's arms" regime). In case of decompensated and terminal stages, children are hospitalized in the resuscitation and intensive care unit.

Non-drug treatment of acute laryngitis

In acute laryngitis, it is necessary to explain to parents that it is necessary to create an environment that excludes negative emotions, since the baby's anxiety may be an additional factor that contributes to and intensifies laryngeal stenosis. It is necessary to provide the patient with access to fresh air in the room where he is located, and humidify the air in the room. It is useful to give the sick child warm alkaline drinks (milk with soda: 1/2 teaspoon of soda per 1 glass of milk, milk with Borjomi mineral water).

In case of acute stenosing laryngitis at the pre-hospital stage, it is necessary to calm the child down if possible and maintain an environment that excludes negative emotions. Before the ambulance arrives, it is necessary to provide access to fresh air in the room where the child is located, the room temperature should be 18-20 °C. Humidify the air in the room where the child is (use wet sheets, a household humidifier), or place the child in the bathroom, filling it with water vapor, it is good at the same time to make warm baths for the child's hands and feet. Only it is important not to overheat the child. Give the patient a warm alkaline drink (milk with soda - 1/2 teaspoon of soda per 1 glass of milk, milk with mineral water).

In hospital, inhalation therapy with isotonic sodium chloride solution through a spacer or nebulizer or by placing the child in a steam-oxygen tent is indicated. In general, inhalation therapy plays a major role in stenosing laryngitis at all stages of treatment.

Drug treatment of acute laryngitis

In acute viral laryngitis, laryngotracheitis, not accompanied by laryngeal stenosis, anti-inflammatory therapy with fenspiride (erespal) is indicated, and in children over 2.5 years of age, anti-inflammatory and bactericidal therapy with fusafungine (bioparox). If the child has an allergic history or atopy, antihistamines are indicated to prevent the development of laryngeal stenosis. Of the symptomatic agents, antipyretics are indicated according to indications, and antitussive drugs with an enveloping effect and mucolytics.

When a sick child develops stage I stenosing laryngitis, fenspiride (erespal) is prescribed. It has been shown that when erespal is prescribed, inflammatory changes are significantly reduced and treatment periods are shortened. Children over 2.5 years of age are prescribed fusafungine (bioparox) for bactericidal and anti-inflammatory purposes.

For a "barking" cough, mucolytics are prescribed, which are administered primarily by inhalation through a nebulizer, but can also be taken orally (if there is no nebulizer):

• Acetylcysteine:
  • inhalations - 150-300 mg per inhalation:
  • up to 2 years: 100 mg 2 times a day, orally;
  • from 2 to 6 years: 100 mg 3 times a day, orally;
  • over 6 years: 200 mg 3 times a day or ACC Long 1 time at night, orally.
• Ambroxol:
  • inhalation - 2 ml of solution per inhalation; for children up to 2 years: syrup 7.5 mg 2 times a day, orally;
  • from 2 to 5 years: syrup 7.5 mg 2-3 times a day, orally:
  • from 5 to 12 years: syrup 15 mg 2-3 times a day, orally;
  • over 12 years: 1 capsule (30 mg) 2-3 times a day, orally. Given the role of the allergic component in the pathogenesis of stenosing laryngitis, 1st generation antihistamines are prescribed: dimethindene (fenistil), chloropyramine (suprastin) or 2nd generation: cetirizine (zirtek), loratadine (claritin).
• Dimethindene (Fenistil) in drops is prescribed for 7-14 days:
  • for children over 1 month and up to 1 year old, 3-10 drops 3 times a day;
  • children 1-3 years old, 10-15 drops 3 times a day;
  • children over 3 years old, 15-20 drops 3 times a day.
• Chloropyramine (suprastin) is prescribed orally for 7-14 days:
  • children 1-12 months old: 6.25 mg 2-3 times a day;
  • children 2-6 years old: 8.33 mg 2-3 times a day.
• Cetirizine (Zyrtec) is prescribed orally to children from 6 months to 2 years old at 2.5 mg 1-2 times a day.
• Loratadine (Claritin) is prescribed orally to children weighing less than 30 kg at 5 mg once a day for 14 days or more.

It is important to remember that some antihistamines, such as promethazine (pipolfen), contribute to drying of the mucous membrane of the larynx and dehydration, thereby worsening the drainage function of the bronchopulmonary system.

In case of hyperthermia, antipyretics are prescribed. Sedatives are also prescribed (rectal suppositories Viburkol). The use of antipyretics and sedatives is necessary, since hyperthermia and agitation contribute to increased respiration and thus contribute to inspiratory dyspnea. However, it is necessary to remember that sleeping pills or neuroplegics in case of viscous mucus in the respiratory tract, relaxing the child and suppressing the cough reflex, can contribute to the aggravation of laryngeal stenosis, since viscous mucus is not removed with a weak cough, but turns into crusts.

At stages II, III and IV of stenosing laryngitis the prescriptions are the same as at stage I, but the use of glucocorticoids is more important and promising, which are becoming the drugs of choice in these situations. Prednisolone is used orally at the rate of 1-2 mg/kg or dexamethasone intramuscularly at 0.4-0.6 mg/kg. The most appropriate is the inhalation administration of glucocorticoids through a nebulizer: fluticasone by inhalation 100-200 mcg 2 times a day or budesonide in suspension 0.5-1-2 mg by inhalation up to 2-3 times a day. Inhalation glucocorticoids (IGCS), in particular budesonide, have local anti-inflammatory, antiallergic and antiexudative effects.

The second drug of choice is a selective short-acting beta1-agonist, salbutamol. For children over 4 years of age, the anticholinergic ipratropium bromide (atrovent) can also be used. Salbutamol is prescribed by inhalation 1-2 doses (100-200 mcg) no more than 3-4 times a day. Ipratropium bromide (atrovent) is used by inhalation 20 mcg (2 doses) 3-4 times a day.

For the etiotropic treatment of viral stenosing laryngitis in severe cases, the drug with recombinant action of interferon alpha-2 (Viferon) is indicated: 1 suppository rectally 2 times a day for 5 days, then after 2 days (on the 3rd day) 1 suppository 2 times a day. There are 3-4 such courses.

In acute laryngitis and acute stenosing laryngitis caused by influenza viruses A and B, especially A, rimantadine can be used in children over one year of age in the first 2 days at the onset of the disease.

At present, specialists are unanimous in the fact that the indication for the use of antibiotics in viral stenosing laryngitis are bacterial complications, i.e. in stages II-III. The use of antibiotics is also justified in the case of bacterial etiology of stenosing laryngitis. Indications for the use of systemic antibiotics:

• mucopurulent or purulent nature of sputum, if any;
• detection of purulent and fibrinous-purulent deposits on the mucous membrane during laryngoscopy;
• phenomena of laryngeal stenosis of II-IV degree;
• protracted course of the disease and its recurrence.

When choosing antibiotics, preference is given to cephalosporins of the 3rd and 4th generations: ceftriaxone, cefotaxime, cefepime). At stages III-IV of stenosing laryngitis, when the child is in the intensive care unit, carbapenems (imipenem, meropenem) are also used, which have a broader spectrum of activity, including Pseudomonas aeruginosa and non-spore-forming anaerobes.

In case of prolonged stenosing laryngitis and recurrent stenosing laryngitis, chlamydial etiology of the infection should be excluded and macrolides (azithromycin, clarithromycin, josamycin, roxithromycin, spiramycin, etc.) should be used. In general, in case of recurrent stenosing laryngitis, recombinant interferon alpha-2 (Viferon) is used in suppositories, 1 suppository 2 times a day for 5-7 days, then 1 suppository 2 times in 3 days, for at least 1-2 months. In addition, in case of recurrent stenosing laryngitis in the convalescence period, to prevent the development of hypersensitivity of the mucous membrane of the larynx and bronchi, long-term hyposensitizing therapy with H1-histamine receptor blockers loratadine or cetirizine is necessary for 1-2 months.

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Surgical treatment of acute laryngitis

If conservative treatment is ineffective, tracheal intubation and tracheostomy are indicated in cases of asphyxia.