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asthma vs. croup
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asthma vs. croup

My 6 year old son has had recurrent moderate to severe (stridor, insp./expatory retractions unresponsive to home care) viral croup 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 and PFTs at baseline are NL.  ***** test has shown reactions which do not seem clinically relevant... but ? predictive of a risk for developing asthma.

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?  We have an apt. w/ ped. pulmnologist pending.  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?
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