Acute Laryngo-Tracheo-Bronchitis: Causes, Features, Treatment

It is an inflammatory condition of the larynx, trachea
and bronchi; more common than acute epiglottitis.
Aetiology
Mostly, it is viral infection (parainfluenza type I and II)
affecting children between 6 months to 3 years of age.
Male children are more often affected. Secondary bacterial
infection by Gram positive cocci soon supervenes.
Pathology
The loose areolar tissue in the subglottic region swells up
and causes respiratory obstruction and stridor. This, coupled
with thick tenacious secretions and crusts, may
completely occlude the airway.
Symptoms:
Disease starts as upper respiratory infection with hoarseness
and croupy cough. There is fever of 39-4’C. This

may be followed by difficulty in breathing and inspiratory
type of stridor. Respiratory difficulty may gradually
increase with signs of upper airway obstruction, i.e.
suprasternal and intercostal recession.

Treatment
1. Hospitalisation is often essential because of the
increasing difficulty in breathing.
2. Antibiotics like ampicillin 50 mg/kg/day in divided
doses is effective against secondary infections due to
gram-positive cocci and H. influenzae.
3. Humidification helps to soften crusts and tenacious
secretions which block tracheobronchial tree.
4. Parenteral fluids are essential to combat dehydration.
5. Steroids, e.g. hydrocortisone 100mg i.v. may be useful
to relieve oedema.
6. Adrenaline racemic adrenaline administered via a
respirator is a bronchodilator and may relieve dyspnoea
and avert tracheostomy.
7. Intubation/tracheostomy is done, should respiratory
obstnlction increase in spite of the above measures.
Tracheostomy is done if intubation is required beyond
72 hours. Assisted ventilation may be required.