Editing Croup

{{Short description|Respiratory infection often caused by a virus}}
{{About|the respiratory condition|the part of a quadruped|rump (animal)|the crop of a bird|crop (anatomy)|the type of casino employee|croupier}}
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{{Good article}}
{{Use dmy dates|date=January 2025}}
{{Infobox medical condition
| name            = Croup
| synonyms        = Croupy cough, subglottic laryngitis, obstructive laryngitis, laryngotracheobronchitis
| pronounce       = {{IPAc-en|k|r|uː|p}}<ref>{{cite web |title=Croup |url=https://www.macmillandictionary.com/pronunciation/british/croup |website=Macmillan |access-date=1 April 2020}}</ref>
| image           = Croup steeple sign.jpg
| caption         = The [[steeple sign]] as seen on an AP neck X-ray of a child with croup
| field           = [[Pediatrics]]
| symptoms        = "Barky" cough, [[stridor]], fever, stuffy nose<ref name=Au10/>
| complications   = 
| duration        = Usually 1–2 days but can last up to 7 days<ref name=Croup09/>
| causes          = Mostly viral<ref name=Au10/>
| diagnosis       = Based on symptoms<ref name=PedN09/>
| differential    = [[Epiglottitis]], airway [[foreign body]], [[bacterial tracheitis]]<ref name=PedN09/><ref name=Cherry08/>
| prevention      = [[influenza vaccine|Influenza]] and [[diphtheria vaccine|diphtheria]] vaccination<ref name=Cherry08/>
| medication      = [[corticosteroids|Steroids]], [[epinephrine]]<ref name=PedN09/><ref name=Cherry08/>
| frequency       = 15% of children at some point<ref name=PedN09/><ref name=Cherry08/>
| deaths          = Rare<ref name=Au10/>
}}

<!-- Definition and symptoms -->
'''Croup''' ({{IPAc-en|k|ɹ|uː|p|}} {{respell|KROOP}}), also known as '''croupy cough''', is a type of [[respiratory infection]] that is usually caused by a [[virus]].<ref name=Au10/> The infection leads to swelling inside the [[trachea]], which interferes with normal breathing and produces the classic symptoms of "barking/brassy" cough, inspiratory [[stridor]], and a [[hoarseness|hoarse voice]].<ref name=Au10/> Fever and [[runny nose]] may also be present.<ref name=Au10>{{cite journal |vauthors=Rajapaksa S, Starr M | title = Croup – assessment and management | journal = Aust Fam Physician | volume = 39 | issue = 5 | pages = 280–2 |date=May 2010 | pmid = 20485713 }}</ref> These symptoms may be mild, moderate, or severe.<ref name=Croup09>{{cite journal | author = Johnson D | title = Croup | journal = BMJ Clin Evid | volume = 2009 | year = 2009 | pmid = 19445760 | pmc = 2907784 }}</ref> It often starts or is worse at night and normally lasts one to two days.<ref name=Thom2013>{{cite journal|last=Thompson|first=M|author2=Vodicka, TA |author3=Blair, PS |author4=Buckley, DI |author5=Heneghan, C |author6=Hay, AD |author7= TARGET Programme, Team |title=Duration of symptoms of respiratory tract infections in children: systematic review.|journal=BMJ (Clinical Research Ed.)|date=11 December 2013|volume=347|pages=f7027|pmid=24335668|doi=10.1136/bmj.f7027 |pmc=3898587}}</ref><ref name=Au10/><ref name=Croup09/>

<!-- Cause and diagnosis -->
Croup can be caused by a number of viruses including [[parainfluenza]] and [[influenza virus]].<ref name=Au10/> Rarely is it due to a [[bacterial infection]].<ref name=Cherry08>{{cite journal | author = Cherry JD | title = Clinical practice. Croup | journal = N. Engl. J. Med. | volume = 358 | issue = 4 | pages = 384–91 | year = 2008 | pmid = 18216359 | doi = 10.1056/NEJMcp072022 }}</ref> Croup is typically diagnosed based on signs and symptoms after potentially more severe causes, such as [[epiglottitis]] or an [[airway foreign body]], have been ruled out.<ref name=PedN09/> Further investigations, such as blood tests, [[X-rays]] and cultures, are usually not needed.<ref name=PedN09>{{cite journal | author = Everard ML | title = Acute bronchiolitis and croup | journal = Pediatr. Clin. North Am. | volume = 56 | issue = 1 | pages = 119–33, x–xi |date=February 2009 | pmid = 19135584 | doi = 10.1016/j.pcl.2008.10.007 }}</ref>

<!-- Prevention and treatment -->
Many cases of croup are preventable by [[immunization]] for [[influenza]] and [[diphtheria]].<ref name=Cherry08/> Most cases of croup are mild and the patient can be treated at home with supportive care. Croup is usually treated with a single dose of [[steroids]] by mouth.<ref name=Au10/><ref name="Gate2018">{{cite journal |vauthors=Aregbesola A, Tam CM, Kothari A, Le ML, Ragheb M, Klassen TP |date=10 January 2023 |title=Glucocorticoids for croup in children. |journal=The Cochrane Database of Systematic Reviews |volume= 2023|issue= 1|pages= CD001955|doi=10.1002/14651858.CD001955.pub5 |pmid=36626194|pmc=9831289 }}</ref> In more severe cases inhaled [[epinephrine]] may also be used.<ref name=Au10/><ref>{{cite journal|last1=Bjornson|first1=C|last2=Russell|first2=K|last3=Vandermeer|first3=B|last4=Klassen|first4=TP|last5=Johnson|first5=DW|title=Nebulized epinephrine for croup in children.|journal=The Cochrane Database of Systematic Reviews|date=10 October 2013|volume=10|issue=10|pages=CD006619|pmid=24114291|doi=10.1002/14651858.CD006619.pub3|pmc=11800190}}</ref> Hospitalization is required in one to five percent of cases.<ref name=CMAJ2013>{{cite journal|last1=Bjornson|first1=CL|last2=Johnson|first2=DW|title=Croup in children.|journal=CMAJ: Canadian Medical Association Journal |date=15 October 2013|volume=185|issue=15|pages=1317–23|pmid=23939212|doi=10.1503/cmaj.121645|pmc=3796596}}</ref>

<!--  Epidemiology and history -->
Croup is a relatively common condition that affects about 15% of children at some point.<ref name=PedN09/> It most commonly occurs between six months and five years of age but may rarely be seen in children as old as fifteen.<ref name=Croup09/><ref name=PedN09/><ref name=CMAJ2013/> It is slightly more common in males than females.<ref name=CMAJ2013/> It occurs most often in autumn.<ref name=CMAJ2013/> Before [[vaccination]], croup was frequently caused by [[diphtheria]] and was often fatal.<ref name=Cherry08/><ref>{{cite book|last1=Steele|first1=Volney|title=Bleed, blister, and purge : a history of medicine on the American frontier|url=https://archive.org/details/bleedblisterpurg0000stee|url-access=registration|date=2005|publisher=Mountain Press|location=Missoula, Mont.|isbn=978-0-87842-505-1|page=[https://archive.org/details/bleedblisterpurg0000stee/page/324 324]}}</ref> This cause is now very rare in the Western world due to the success of the [[DPT vaccine|diphtheria vaccine]].<ref name=history>{{cite book |author=Feigin, Ralph D. |title=Textbook of pediatric infectious diseases |publisher=Saunders |location=Philadelphia |year=2004 |page=252 |isbn=978-0-7216-9329-3 }}</ref>

==Signs and symptoms==
{{listen 
 | filename     = Stridor 2OGG.ogg
 | title        = Stridor
 | description  = Inspiratory and expiratory stridor in a 13-month child with croup.
 | format       = [[Ogg]]
}}
{{Listen|description=Croup cough in an 11-month child with croup.|filename=Croup.ogg|format=[[OGG]]|title=Croupy cough}}

Croup is characterized by a "barking" cough, [[stridor]], [[hoarseness]], and [[shortness of breath|difficult breathing]] which usually worsens at night.<ref name=Au10/> The "barking" cough is often described as resembling the call of a sea lion.<ref name=Cherry08/>  The stridor is worsened by agitation or [[crying]], and if it can be heard at rest, it may indicate critical narrowing of the airways. As croup worsens, stridor may decrease considerably.<ref name=Au10/>

Other symptoms include fever, [[coryza]] (symptoms typical of the [[common cold]]), and indrawing of the [[chest wall]]–known as [[Hoover's sign (pulmonary)|Hoover's sign]].<ref name=Au10/><ref name=Alberta07>{{cite web |url=http://policyandorders.cw.bc.ca/resource-gallery/Documents/BC%20Children%27s%20Hospital/C-05-07-60048%20Diagnosis%20and%20Management%20of%20Croup.pdf |title=Diagnosis and Management of Croup |work=BC Children's Hospital Division of Pediatric Emergency Medicine Clinical Practice Guidelines |access-date=2020-03-16 |archive-date=2020-06-23 |archive-url=https://web.archive.org/web/20200623003518/http://policyandorders.cw.bc.ca/resource-gallery/Documents/BC%20Children%27s%20Hospital/C-05-07-60048%20Diagnosis%20and%20Management%20of%20Croup.pdf |url-status=dead }}</ref>  [[Drooling]] or a very sick appearance can indicate other medical conditions, such as [[epiglottitis]] or [[tracheitis]].<ref name=Alberta07/>

==Causes==
Croup is usually deemed to be due to a viral infection.<ref name=Au10/><ref name=PedN09/> Others use the term more broadly, to include acute laryngotracheitis ([[laryngitis]] and [[tracheitis]] together), spasmodic croup, laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis. The first two conditions involve a viral infection and are generally milder with respect to symptomatology; the last four are due to bacterial infection and are usually of greater severity.<ref name=Cherry08/>

===Viral===
Viral croup or acute laryngotracheitis is most commonly caused by [[parainfluenza virus]] (a member of the [[Paramyxoviridae|paramyxovirus]] family), primarily types 1 and 2, in 75% of cases.<ref name=Croup09/> Other viral causes include [[influenza]] A and B, [[measles]], [[adenovirus]] and [[respiratory syncytial virus]] (RSV).<ref name=Cherry08/> Spasmodic croup is caused by the same group of viruses as acute laryngotracheitis, but lacks the usual signs of infection (such as fever, sore throat, and increased [[white blood cell count]]).<ref name=Cherry08/>  Treatment, and response to treatment, are also similar.<ref name=Croup09/>

===Bacteria and cocci ===
Croup caused by a bacterial infection is rare.<ref name=":1" /> Bacterial croup may be divided into laryngeal diphtheria, bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis.<ref name=Cherry08/>  Laryngeal diphtheria is due to ''[[Corynebacterium diphtheriae]]'' while bacterial tracheitis, laryngotracheobronchitis, and laryngotracheobronchopneumonitis are usually due to a primary viral infection with secondary bacterial growth.  The most common cocci implicated are ''[[Staphylococcus aureus]]'' and ''[[Streptococcus pneumoniae]]'', while the most common bacteria are ''[[Haemophilus influenzae]]'', and ''[[Moraxella catarrhalis]]''.<ref name=Cherry08/>

==Pathophysiology==
The viral infection that causes croup leads to swelling of the [[larynx]], [[Vertebrate trachea|trachea]], and large [[bronchi]]<ref name=PedN09/> due to infiltration of [[white blood cells]] (especially [[histiocytes]], [[lymphocytes]], [[plasma cells]], and [[neutrophils]]).<ref name=Cherry08/> Swelling produces airway obstruction which, when significant, leads to dramatically increased work of breathing and the characteristic turbulent, noisy airflow known as [[stridor]].<ref name=PedN09/>

==Diagnosis==
Croup is typically diagnosed based on signs and symptoms.<ref name=PedN09/> The first step is to exclude other obstructive conditions of the upper airway, especially [[epiglottitis]], an airway [[foreign body]], [[subglottic stenosis]], [[angioedema]], [[retropharyngeal abscess]], and [[bacterial tracheitis]].<ref name=PedN09/><ref name=Cherry08/>

A frontal [[X-ray]] of the neck is not routinely performed,<ref name=PedN09/> but if it is done, it may show a characteristic narrowing of the trachea, called the [[steeple sign]], because of the subglottic stenosis, which resembles a [[Steeple (architecture)|steeple]] in shape.  The steeple sign is suggestive of the diagnosis, but is absent in half of cases.<ref name=Alberta07/>

Other investigations (such as [[blood test]]s and [[viral culture]]) are discouraged, as they may cause unnecessary agitation and thus worsen the stress on the compromised airway.<ref name=PedN09/> While viral cultures, obtained via [[nasopharyngeal]] aspiration, can be used to confirm the exact cause, these are usually restricted to research settings.<ref name=Au10/> Bacterial infection should be considered if a person does not improve with standard treatment, at which point further investigations may be indicated.<ref name=Cherry08/>

===Severity===
{| class="wikitable" style="float: right; margin-left; text-align:center"
|+ '''Westley score: Classification of croup severity'''<ref name=Croup09/><ref name=Peds99/> 
|-
! rowspan="2" |Feature
! colspan="6" |Number of points assigned for this feature
|-
!0
!1
!2
!3
!4
!5
|-
| Chest wall<br /> retraction
| style="width:50px;"|None
| style="width:50px;"|Mild
| style="width:50px;"|Moderate
| style="width:50px;"|Severe
| style="width:50px;"|
| style="width:50px;"|
|-
| [[Stridor]]
| None
| With<br /> agitation
| At rest
| 
| 
| 
|-
| [[Cyanosis]]
| None
|  
|  
|  
| With<br /> agitation
| At rest
|-
| [[Level of consciousness|Level of<br />consciousness]]
| Normal
| 
| 
| 
| 
| Disoriented
|-
| Air entry
| Normal
| Decreased
| Markedly decreased
| 
| 
| 
|}
The most commonly used system for classifying the severity of croup is the Westley score. It is primarily used for research purposes rather than in clinical practice.<ref name=Cherry08/> It is the sum of points assigned for five factors: level of consciousness, cyanosis, stridor, air entry, and retractions.<ref name=Cherry08/> The points given for each factor is listed in the adjacent table, and the final score ranges from 0 to 17.<ref name=Peds99/>
* A total score of ≤ 2 indicates ''mild'' croup. The characteristic barking cough and hoarseness may be present, but there is no stridor at rest.<ref name=Croup09/>
* A total score of 3–5 is classified as ''moderate'' croup.  It presents with easily heard stridor, but with few other signs.<ref name=Croup09/>
* A total score of 6–11 is ''severe'' croup.  It also presents with obvious stridor, but also features marked [[chest wall]] indrawing.<ref name=Croup09/>
* A total score of ≥ 12 indicates impending [[respiratory failure]].  The barking cough and stridor may no longer be prominent at this stage.<ref name=Croup09/>

85% of children presenting to the emergency department have mild disease; severe croup is rare (<1%).<ref name=Croup09/>

==Prevention==
Croup is contagious during the first few days of the infection.<ref name=":1" /> Basic hygiene including hand washing can prevent transmission.<ref name=":1" /> There are no vaccines that have been developed to prevent croup,<ref name=":1" /> however, many cases of croup have been prevented by [[immunization]] for [[influenza]] and [[diphtheria]].<ref name=Cherry08/> At one time, croup referred to a diphtherial disease, but with vaccination, diphtheria is now rare in the developed world.<ref name=Cherry08/>

==Treatment==
Most children with croup have mild symptoms and supportive care at home is effective.<ref name=":1">{{Cite journal|last1=Baiu|first1=Ioana|last2=Melendez|first2=Elliot|date=23 April 2019|title=Croup|journal=JAMA|language=en|volume=321|issue=16|pages=1642|doi=10.1001/jama.2019.2013|pmid=31012936 |s2cid=242149254 |issn=0098-7484|doi-access=free}}</ref> For children with moderate to severe croup, treatment with corticosteroids and nebulized epinephrine may be suggested. Steroids are given routinely, with [[epinephrine]] used in severe cases.<ref name=PedN09/> Children with [[oxygen saturation]] less than 92% should receive oxygen,<ref name=Cherry08/> and those with severe croup may be hospitalized for observation.<ref name=Alberta07/> In very rare severe cases of croup that result in respiratory failure, emergency intubation and ventilation may be required.<ref name=":0">{{Cite journal|last1=Moraa|first1=Irene|last2=Sturman|first2=Nancy|last3=McGuire|first3=Treasure M.|last4=van Driel|first4=Mieke L.|date=16 August 2021|title=Heliox for croup in children|url=|journal=The Cochrane Database of Systematic Reviews|volume=2021|issue=8 |pages=CD006822|doi=10.1002/14651858.CD006822.pub6|issn=1469-493X|pmc=8406495|pmid=34397099}}</ref> With treatment, less than 0.2% of children require [[endotracheal intubation]].<ref name="Peds99">{{cite journal | author = Klassen TP | title = Croup. A current perspective | journal = Pediatr. Clin. North Am. | volume = 46 | issue = 6 | pages = 1167–78 |date=December 1999 | pmid = 10629679 | doi = 10.1016/S0031-3955(05)70180-2 }}</ref> Since croup is usually a viral disease, [[antibiotics]] are not used unless secondary bacterial infection is suspected.<ref name="Au10" /> The use of [[cough medicine]]s, which usually contain [[dextromethorphan]] or [[guaifenesin]], are also discouraged.<ref name="Au10" />

=== Supportive care ===
Supportive care for children with croup includes resting and keeping the child hydrated.<ref name=":1" /> Infections that are mild are suggested to be treated at home. Croup is contagious so washing hands is important.<ref name=":1" /> Children with croup should generally be kept as calm as possible.<ref name="PedN09" /> Over the counter medications for pain and fever may be helpful to keep the child comfortable.<ref name=":1" /> There is some evidence that cool or warm mist may be helpful, however, the effectiveness of this approach is not clear.<ref name="PedN09" /><ref name="Cherry08" /><ref name=":1" /> If the child is showing signs of distress while breathing ([[inspiratory stridor]], working hard to breathe, blue (or blue-ish) coloured lips, or decrease in the level of [[alertness]]), immediate medical evaluation by a doctor is required.<ref name=":1" />

===Steroids===
[[Corticosteroids]], such as [[dexamethasone]] and [[budesonide]], have been shown to improve outcomes in children with all severities of croup, however, the benefits may be delayed.<ref name="Gate2018" /> Significant relief may be obtained as early as two hours after administration.<ref name=Gate2018/> While effective when given [[parenteral|by injection]], or by inhalation, giving the medication by mouth is preferred.<ref name=PedN09/> A single dose is usually all that is required, and is generally considered to be quite safe.<ref name=PedN09/> Dexamethasone at doses of  0.15, 0.3 and 0.6&nbsp;mg/kg appear to be all equally effective.<ref>{{cite journal | author = Port C | title = Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 4. Dose of dexamethasone in croup | journal = Emerg Med J | volume = 26 | issue = 4 | pages = 291–2 |date=April 2009 | pmid = 19307398 | doi = 10.1136/emj.2009.072090 | s2cid = 6655787 }}</ref>

===Epinephrine===
Moderate to severe croup (for example, in the case of severe stridor) may be improved temporarily with [[nebulizer|nebulized]] [[epinephrine]].<ref name=PedN09/> While epinephrine typically produces a reduction in croup severity within 10–30 minutes, the benefits are short-lived and last for only about 2 hours.<ref name=Au10/><ref name=PedN09/> If the condition remains improved for 2–4 hours after treatment and no other complications arise, the child is typically discharged from the hospital.<ref name=Au10/><ref name=PedN09/> Epinephrine treatment is associated with potential adverse effects (usually related to the dose of epinephrine) including [[tachycardia]], [[arrhythmia]]s, and [[hypertension]].<ref name=":0" />

=== Oxygen ===
More severe cases of croup may require treatment with oxygen. If oxygen is needed, "blow-by" administration (holding an oxygen source near the child's face) is recommended, as it causes less agitation than use of a [[oxygen mask|mask]].<ref name="Cherry08" />

===Other===
While other treatments for croup have been studied, none has sufficient evidence to support its use.  There is tentative evidence that breathing [[heliox]] (a mixture of [[helium]] and [[oxygen]]) to decrease the work of breathing is useful in those with severe disease, however, there is uncertainty in the effectiveness and the potential adverse effects and/or side effects are not well known.<ref name=":0" />  In cases of possible secondary bacterial infection, the antibiotics [[vancomycin]] and [[cefotaxime]] are recommended.<ref name=Cherry08/> In severe cases associated with [[Influenza A virus|influenza&nbsp;A]] or [[Influenza B virus|B]] infections, the [[antiviral drug|antiviral]] [[neuraminidase inhibitors]] may be administered.<ref name=Cherry08/>

==Prognosis==
Viral croup is usually a [[Self-limiting (biology)|self-limiting]] disease,<ref name=Au10/> with half of cases resolving in a day and 80% of cases in two days.<ref name=Thom2013/> It can very rarely result in death from [[respiratory failure]] and/or cardiac arrest.<ref name=Au10/>  Symptoms usually improve within two days, but may last for up to seven days.<ref name=Croup09/> Other uncommon complications include [[bacterial tracheitis]], [[pneumonia]], and [[pulmonary edema]].<ref name=Croup09/>

==Epidemiology==
Croup affects about 15% of children, and usually presents between the ages of 6 months and 5–6 years.<ref name=PedN09/><ref name=Cherry08/> It accounts for about 5% of hospital admissions in this population.<ref name=Croup09/> In rare cases, it may occur in children as young as 3 months and as old as 15 years.<ref name=Croup09/> Males are affected 50% more frequently than are females, and there is an increased [[prevalence]] in autumn.<ref name=Cherry08/>

==History==
The word ''croup'' comes from the [[Early Modern English]] verb ''croup'', meaning "to cry hoarsely." The noun describing the disease originated in southeastern Scotland and became widespread after [[Edinburgh]] physician [[Francis Home]] published the 1765 treatise ''An Inquiry into the Nature, Cause, and Cure of the Croup''.<ref>{{cite book |last1=Kiple |first1=Kenneth |title=The Cambridge World History of Human Disease |date=29 January 1993 |publisher=Cambridge University Press |location=Cambridge |pages=654–657 |doi=10.1017/CHOL9780521332866.092 }}</ref><ref>{{cite web |title=croup {{!}} Origin and meaning of croup by Online Etymology Dictionary |url=http://www.etymonline.com/index.php?term=croup |website=www.etymonline.com |access-date=27 February 2020 |archive-url=https://web.archive.org/web/20110510032149/http://www.etymonline.com/index.php?term=croup |archive-date=2011-05-10 |language=en}}</ref>

[[Diphtheritic croup]] has been known since the time of [[Homer]]'s [[ancient Greece]], and it was not until 1826 that viral croup was differentiated from croup due to [[diphtheria]] by [[Pierre Bretonneau|Bretonneau]].<ref name=history/><ref name="Hist2001">{{cite journal|author=Marchessault V|date=November 2001|title=Historical review of croup|journal=Can J Infect Dis|volume=12|issue=6|pages=337–9|doi=10.1155/2001/919830|pmc=2094841|pmid=18159359|doi-access=free}}</ref> Viral croup was then called "faux-croup" by the French and often called "false croup" in English,<ref name=cormack>{{cite journal|last=Cormack|first=John Rose|title=Meaning of the Terms Diphtheria, Croup, and Faux Croup|journal=[[British Medical Journal]]|date=8 May 1875|volume=1|number=749|page=606|doi=10.1136/bmj.1.749.606|pmid=20747853|pmc=2297755}}</ref><ref name=loving>{{cite journal|last=Loving|first=Starling|title=Something concerning the diagnosis and treatment of false croup|journal=[[JAMA (journal)|JAMA: The Journal of the American Medical Association]]|date=5 October 1895|volume=XXV|number=14|pages=567–573|url=https://books.google.com/books?id=-FQcAQAAMAAJ&pg=PA567|access-date=16 April 2014|doi=10.1001/jama.1895.02430400011001d|url-status=live|archive-url=https://web.archive.org/web/20140704192208/http://books.google.com/books?id=-FQcAQAAMAAJ&pg=PA567|archive-date=4 July 2014}}</ref> as "croup" or "true croup" then most often referred to the disease caused by the [[Corynebacterium diphtheriae|diphtheria bacterium]].<ref name=bennett>{{cite journal|last=Bennett|first=James Risdon|title=True and False Croup|journal=[[British Medical Journal]]|date=8 May 1875|volume=1|number=749|pages=606–607|doi=10.1136/bmj.1.749.606-a|pmid=20747854|pmc=2297754}}</ref><ref name=beard>{{cite book|last=Beard|first=George Miller|title=Our Home Physician: A New and Popular Guide to the Art of Preserving Health and Treating Disease|year=1875|publisher=E. B. Treat|location=New York|pages=[https://archive.org/details/ourhomephysicia00beargoog/page/n567 560]–564|url=https://archive.org/details/ourhomephysicia00beargoog|access-date=15 April 2014}}</ref> False croup has also been known as pseudo croup or spasmodic croup.<ref>{{cite book|title=Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases|date=2014|publisher=Elsevier Health Sciences|isbn=978-0-323-26373-3|page=762|edition=8|url=https://books.google.com/books?id=73pYBAAAQBAJ&pg=PA762|url-status=live|archive-url=https://web.archive.org/web/20170908183854/https://books.google.com/books?id=73pYBAAAQBAJ&pg=PA762|archive-date=2017-09-08}}</ref> Croup due to diphtheria has become nearly unknown in affluent countries in modern times due to the advent of effective [[immunization]].<ref name=history/><ref name=vanderpool>{{cite journal|last=Vanderpool|first=Patricia|title=Recognizing croup and stridor in children|journal=American Nurse Today|date=December 2012|volume=7|number=12|url=http://www.americannursetoday.com/article.aspx?id=9752&fid=9722|access-date=15 April 2014|url-status=dead|archive-url=https://web.archive.org/web/20140416174601/http://www.americannursetoday.com/article.aspx?id=9752&fid=9722|archive-date=16 April 2014}}</ref>

One famous fatality of croup was [[Napoleon]]'s designated heir, [[Napoléon Charles Bonaparte]]. His death in 1807 left Napoleon without an heir and contributed to his decision to divorce from his wife, the Empress [[Josephine de Beauharnais]].<ref>{{Cite book|last=Bruce|first=Evangeline|title=Napoleon and Josephine|publisher=Weidenfeld & Nicolson|year=1995|location=London}}</ref>

[[Preston Brooks]], a pro-slavery, pre-[[American Civil War|Civil War]] [[US House of Representatives|US congressman]] from South Carolina died unexpectedly from a violent attack of croup on January 27, 1857, a few weeks before the March 4 start of the new congressional term to which he had been re-elected.<ref>{{cite news |date=January 28, 1857 |title=Death of Preston S. Brooks |url=https://www.newspapers.com/image/145333774/ |newspaper=Washington Evening Star |location=Washington, DC |page=2 |url-access=subscription }}</ref>

==References==
{{Reflist}}

==External links==
{{Sister project links|display=Croup|v=no|n=no|b=no|q=no|s=no}}
* {{cite web | url = https://medlineplus.gov/croup.html | publisher = U.S. National Library of Medicine | work = MedlinePlus | title = Croup }}

{{Medical resources
 | DiseasesDB     = 13233
 | ICD10          = {{ICD10|J|05|0|j|00}}
 | ICD9           = {{ICD9|464.4}}
 | ICDO           =
 | OMIM           =
 | MedlinePlus    = 000959
 | eMedicineSubj  = ped
 | eMedicineTopic = 510
 | eMedicine_mult = {{eMedicine2|emerg|370}} {{eMedicine2|radio|199}}
 | MeshID         = D003440
}}
{{Respiratory pathology}}

[[Category:Animal viral diseases]]
[[Category:Acute upper respiratory infections]]
[[Category:Pediatrics]]
[[Category:Wikipedia emergency medicine articles ready to translate]]
[[Category:Wikipedia medicine articles ready to translate (full)]]
[[Category:Cough]]
[[Category:Otorhinolaryngology]]