Wednesday, March 14, 2007

Croup and Albuterol

I have been getting a lot of search hits lately for the search "Croup and Albuterol." To justify my presence on the search engines, here's my opinion on it, but first here is a disclaimer: I am not a physician. I am no longer a practicing Respiratory Therapist. Take any advice here with a huge grain of salt and remember to consult a real doctor before you make any decisions about anything. Moving on.

Croup, which we all know and love as that barky sound that kids make, is caused by swelling in the airway. The trachea and air passages are swollen and inflamed, and it makes kids feel tight and wheezy and sound scary.

Albuterol is an overprescribed Beta-2 agonist. It works very well for bronchospasm, and is sometimes used to lower serum Potassium. But that is all it does. Read this again: it is a BRONCHODILATOR. It does not cause swelling to go down: it causes the bronchioles to dilate if the muscles that control them are tightening up. I cannot emphasize enough that it does NOT reduce swelling: it simply relaxes the smooth muscles around the bronchioles.

Now, let's apply logic: bronchodilators work when someone has bronchospasm, usually asthmatic or emphesematic in nature. Croup is a problem with swelling in the airways. It is not a problem of bronchospasm, although it can cause it in asthmatic children. Albuterol will NOT....repeat, NOT...cause airway swelling to go down. Racemic Epinephrine, the usual prescription for croup, will cause airway swelling to go down.

So is it smart to use albuterol for croup? No. Unless the child with croup is asthmatic or has a history of some sort of RAD, it is unacceptable and bordering on malpractice to prescribe albuterol for croup. Racemic epinephrine and steroids will cure croup. Albuterol will not.

To conclude, I would just like to say this: the only physicians I have ever seen prescribe albuterol for croup on a routine basis have been, without exception, ignorant, old-school, unchanging buffoons who should not be practicing medicine in the first place because it's been thirty years since the bothered to read a medical journal. Seriously, these guys are the kind of doctors who are likely to order trepanning and bloodletting for headaches and infections.

Albuterol is NOT a cure-all. Do not prescribe it unless the child has asthma. It will do nothing and it will make the respiratory therapist despise you and think you are an idiot. End of discussion.

7 comments:

Anonymous said...

If your child were in an African hospital with no other medicine available and was in distress from croup, would albuterol do damage? Would it even be worth a try if there were no other options? Or are there other options if there is no medicine available except someone else's nebulizer? I have friends in that situation tonight. A medical evacuation will cost them 35,000 USD they don't have.

Rebecca Cason said...

Thankyou for this article. My sons get croup in season and out of season...i go through boxes and boxes of albuterol and i know that it does not work but yet the doctors refuse to give me anything esle and then make me feel like the idiot when i rush to the er at 2 in the morning when my sons lips are blue telling me its just croup!! Then they give him racemic epi and hes good as new...but as soon as i leave what am i to do...they wont prescribe me the epi. I hope you dont mind but im printing this out and taking it to the doctor..its the first thing ive heard that makes any sense! Thanks.

Kristin said...

Does the Pulmicort inhalants work for croup?

My son currently has the croup and I have some Pulmicort to put in his breathing treatment machine, but didn't know if it would help with the swelling...

Barb said...

Thank you for the info. We're in the middle of a severe croup attack and have albuterol for asthmatic sister, and we were tempted to use it. Still wonder if the severity of the attack might indicate this daughter is asthmatic as well.

jen said...

thank you thank you thank you!!!!!! i've been dealing with recurrent croup in my daughter, so severe at times her pulse-oxygen saturation has gotten down to 65% and 74% by the time paramedics arrive. Her FORMER ENT said to give her albuterol during these episodes.. UMM NO that didn't help whatsoever(not even a little tiny bit), and took time away from when we could have been trying things that might've worked better. THANK YOU again!.

Anonymous said...

Though I admire the comments regarding the pathophysiology of croup and the recommended treatment, I have to disagree with the comments of the author about the "ignorance" of physicians who use Albuterol. First, you don't have to be in Africa to find yourself practicing in a clinic where you lack Racemic epi or even cool mist nebs as treatment options. Okay, Albuterol may not provide efficacy if this is completely croup, but even the author mentioned that it treats asthma. Kids with asthma will have symptoms at some time PRIOR to their first dx of this disease. Often, asthma comes out for the first time with acute illnesses--so is their harm in using Albuterol. I think the only harm is the possible wrath of single minded respiratory therapist who fail to realize the limitations sometimes of the treatment modalities at your disposal and refuse to recognize the "art" of medicine and tend to focus only on the science. Though I am sure there are those of us who are ignorant, but I believe that if you have a discussion with these docs you will learn a world of patient care!

Anonymous said...

thank you soooooo much for this article, my dr just prescribed this for my child for croup. I thought albuterol was something for chf, so I googled it and found your post. I will not be giving it to my child... thanks again.