croup work-up and dx.

[colfield222]

My 6 year old son has had recurrent moderate to severe (stridor, insp./expatory retractions unresponsive to home care) croup w/ virus infection 1 -2 times per year since 9 months of age.  He is treated w/ racemic Epi and decadron in the ER and has needed hospital admission 5 times (never intubated).  We see pediatrician, allergist/asthma specialist, and have seen peds. ENT.  Bronchoscpy normal,  ***** test has shown reactions which do not seem clinically relevant... but ? predictive of a risk for developing asthma, PFTs/NO2 test normal, Xray NL except steeple sign during acute attack.

Prevention?  Currently he is on pulmnicort inhaler 2 puffs Q AM and we have prednisolone to dose PRN if early suspicion of croup is present (i.e. hoarseness + suspicious cough).  Since he has not shown signs of small airway reactivity is the pulmnicort inhaler of any use?  

Pediatric pulmonolgist rec. upper gi series and 12 wks of prevacid though he has no signs of GERD.

Any other tests that are strongly rec. for this situation?
Any other ideas re. prevention plan?  
Do your patients ever have racemic epi at home to dose before heading to the hospital or calling 911?  What risk am I for airway occlusion?

[ivorything]

Hello! I know this is a very old post but I have the exact same question you do with my 11 month old. Twice he has develop inspiratory stridor at rest and he responded well to racemic epi and oral steroids but we had to call EMS both times and then wait in the ER for the mandatory four hours to confirm he didn't need another dose of the rac epi. I would absolutely love to have a nebulizer and the oral steroids at home so we can treat him first before heading in each time. It's happened twice and it seems random which viruses cause it and which don't. Were you ever able to get a prescription?

[Sara_MHModerator]

Hello.  I wanted to check in with you ivorything.  I think with this history, a case can absolutely be made to receive that at home nebulizer.  Have you made any progress with that?

[Connors_terrified_mom]

Hey, we are in the same boat...
My five year old son has had recurrent, progressive, croup like symptoms for years.  We have prescriptions for both raci epi nebs and for decadron by mouth.  I know here in FL, the ambulance does not carry raci epi neb so we had to have it.  It could save his life.  Most of the time he needs more than two doses though so we end up in the ER anyway.  
I recommend, if it gets worse to have him scoped acutely.  Connor's broncoscopy was normal in between episodes but last weekend when he was admitted they scoped him and his airway was riddled with yeast...  this could be from prolonged use of steroids, (inhaled and nasal along with by mouth and antibiotics.)   I am curious to see if long term cadidas (yeast) is the culprit for recurrent croup.  
Right now we are playing the waiting game.  Connor is being treated with Diflucan to clear up the yeast...  if that is the cause then hopefully he will not have another episode.  
Either way, I feel your pain and I hope you find answers...  You should know that scoping an acutely ill airway may leave your child in the PICU, like mine...  but just for a night... and at least we found out about the yeast.
good luck
gra