Objective: Determination of main causes of severe obstructive dyspnea (SOD) with emphasis on bacterial tracheitis. Population and Methods: Hospital records of patients hospitalized for SOD from January 1986 to December 95 were reviewed. Diagnostic criteria for BT were clinical. Blood cultures and tracheal aspirates for culture were taken immediately after intubation and IV antibiotics initiated thereafter. RESULTS: 202 cases of SOD were recorded including 171 laryngotracheobronchitis, 1 epiglottitis and 15 BT. 27 patients needed intubation including 3 LTB, 15 BT, and 1 epiglottitis. The age of BT patients ranged between 26 days and 13 years. Fourteen occurred in the cold season. All patients had signs of URTI 5-120 hours prior to admission. Respiratory distresses (inspiratory stridor +/- expiratory wheezes) and cyanosis were the main clinical features on admission. Drooling and hyperextension of the neck were absent. Twelve patients required immediate intubation, 3 intubated few hours later were initially diagnosed as reactive airway disease. Tracheal aspirates showed dense growth of Staphylococcus aureus in 6 , Viridans Streptococcus in 3, hemolytic Streptococcus Group in 2 and Haemophilus influenzae in 4. Only one had a positive blood culture for Streptococcus pneumonia. Initial chest roentgenogram showed patchy infiltrates or bilateral hyperinflation. Fine mucosal irregularities of the trachea (lateral neck) were noted in 4. Assisted ventilation was needed in 8 patients for 4-120 hours. Frequent endotracheal aspirations were necessary in all cases during the first 24 hours. Extubation was possible after 24-144 hours. Two patients developed adult respiratory distress syndrome, one of them died. Conclusion: BT is the main cause of SOD requiring intubation in this community. Epiglottitis is rare.