Laryngotracheobronchitis--a continuing challenge in child health care

Laryngotracheobronchitis (LTB) continues to occur in epidemics necessitating many hospital admissions. A short barking cough, stridor with a crowing sound on inspiration, and retractions of the intercostal respiratory muscles are hallmarks of the disease. LTB is most frequently a viral disease causing acute inflammation of the subglottic area, the trachea, and the segmental bronchus. Increasing subglottic edema and generalized fatigue of patients with this disease can cause progression of airway obstruction. Respiratory and cardiac arrest follow unless an immediate airway is established. The management of LTB is primarily medical and consists of moist air, sedation, close observation, and occasionally antibiotics. Patients with respiratory difficulties severe enough to require intubation should undergo direct laryngoscopy and bronchoscopy to rule out other causes of airway obstruction.