Many people think of croup as a childhood illness, but adults can also experience this alarming condition. If you or a loved one are dealing with croup, understanding its impact and potential complications is essential. This article provides an overview of how croup affects adults, addressing key concerns and offering practical advice.
What is croup?
Croup is a respiratory disease caused by a viral infection.1 It leads to swelling in the upper airways, particularly around the larynx (voice box) and the trachea (windpipe). The defining feature of croup is a unique barking cough, often compared to the seal’s noise. Other symptoms include hoarseness, difficulty breathing, and a high-pitched whistling sound known as stridor.
Causes of croup in adults
While croup is most prevalent in children aged six months to three years, adults can get the infection too.2 The same viruses that cause croup in children, such as parainfluenza, influenza, adenovirus, and respiratory syncytial virus (RSV), can infect adults. Adults with weakened immune systems, chronic respiratory conditions, or prolonged exposure to infected individuals are at higher risk.
Symptoms of croup in adults
Croup symptoms in adults vary in severity. Common symptoms include:3,8
- Barking cough: this is the most recognisable symptom
- Hoarseness: the swelling affects the vocal cords, making the voice raspy
- Stridor: a high-pitched wheezing sound during inhalation
- Difficulty breathing: swelling can restrict airflow, causing shortness of breath
- Fever: mild to moderate fever may accompany the infection
Airway obstruction
Swelling in the upper airway significantly obstructs breathing.4 The result is severe respiratory difficulties, often necessitating emergency medical intervention. Adults may feel suffocated, experience an increased respiratory rate, and develop cyanosis (blue/grey skin or lips due to oxygen deficiency).
Secondary infections
Croup often leads to secondary bacterial infections, such as pneumonia or bronchitis.5 Such complications worsen the patient's condition, necessitating antibiotics and prolonging recovery. Persistent fever, chest pain, and a productive cough are telltale signs of a secondary infection.
Chronic respiratory conditions
Frequent croup episodes or severe initial infection may result in long-term respiratory issues,6 for example, the development or exacerbation of conditions like chronic obstructive pulmonary disease (COPD) or asthma. Symptoms to watch for include persistent cough, wheezing and reduced lung function.
Voice and throat problems
Ongoing inflammation and swelling of the vocal cords can cause permanent damage.11 This damage may turn into chronic hoarseness, vocal fatigue, or even voice loss. Complications like these are especially challenging for adults who depend on their voice for their profession, such as singers or teachers.
Sleep apnoea
Swelling and airway obstruction often lead to sleep apnoea, which is characterised by repeated interruptions in breathing during sleep.10 Symptoms include loud snoring, choking sounds during sleep, and excessive daytime sleepiness. Medical attention is essential to prevent further health issues from sleep apnea.
Additional complications to consider
Adult croup can also give rise to several less common complications.
Laryngeal stenosis
Severe and prolonged swelling causes laryngeal stenosis, a narrowing of the larynx. Chronic breathing difficulties and frequent respiratory infections are common symptoms, which may require surgical intervention to widen the airway.
Pulmonary oedema
Fluid can accumulate in the lungs, resulting in extreme breathing difficulties, wheezing, and a sensation of drowning.12 Immediate medical intervention is necessary to manage this life-threatening complication.
Dehydration
Fever can cause an increase in respiratory rate and reduced fluid intake, which may result in dehydration. Symptoms include a dry mouth, excessive thirst, dark urine and dizziness. Thus, adequate hydration is essential in managing croup. In severe cases, intravenous fluids are required.
Treatment for croup in adults
Effective treatment is vital for managing croup in adults and preventing complications.9 Options include:
Hydration and rest
Adequate hydration helps to thin mucus and ease coughing. Rest is crucial to support the immune system in fighting the infection. Adults should drink lots of fluids and avoid strenuous activities until full recovery.
Humidified air
Moist air can provide relief for inflamed airways. Using a humidifier or taking a hot shower can be beneficial. Inhaling steam for several minutes offers temporary relief from symptoms.
Medications
Medications such as paracetamol or ibuprofen help reduce fever and discomfort. In more severe cases, doctors might prescribe corticosteroids to reduce airway inflammation and swelling. These medications usually offer rapid relief with just a single dose.
Antibiotics
If a secondary bacterial infection is suspected, antibiotics are prescribed. Completing the entire course of antibiotics is needed to eradicate the infection entirely.
Emergency care
Severe airway obstruction or difficulty breathing requires immediate medical attention. Treatment may involve oxygen therapy, nebulised adrenaline, or even intubation to secure the airway.
Alternative and complementary therapies
While traditional treatments are necessary, complementary therapies can support recovery and alleviate symptoms. Always consult a healthcare provider before trying any alternative treatments.
Herbal remedies
Herbs like eucalyptus, thyme, and liquorice root possess anti-inflammatory and soothing properties.13 These can be prepared as teas, lozenges, or steam inhalants to reduce symptoms. However, it's important to ensure they do not interact with your medications.
Aromatherapy
Essential oils such as eucalyptus, peppermint, and lavender can help ease respiratory symptoms.14 Using a diffuser or inhaling steam infused with these oils can provide relief. Care should be taken with the concentration and duration of use.
Vitamin and mineral supplements
Boosting the immune system with vitamins and minerals like vitamin C, D, and zinc can help the body fight infection.15 Discuss the appropriate dosage with your doctor to ensure these supplements do not interfere with your medications.
Preventing croup in adults
Preventing croup is preferable to treating it.16 Here are steps to reduce the risk of contracting the infection:
- Good hygiene: regular handwashing and avoiding close contact with infected individuals helps reduce the risk of viral infections
- Vaccination: staying current with flu vaccines and other vaccinations can protect against some viruses that cause croup
- Healthy lifestyle: maintaining a strong immune system is key. A balanced diet, regular exercise, adequate sleep, and stress management contribute to overall health
- Avoid smoking: smoking and exposure to second-hand smoke damage the respiratory system and increase susceptibility to infections
When to see a doctor
Knowing when to seek medical advice is crucial. Adults with croup should consult a healthcare provider if they experience:
- Severe or worsening symptoms
- Difficulty breathing or swallowing
- Persistent high fever
- Signs of secondary infection, such as chest pain or productive cough
- Symptoms of sleep apnoea
Early intervention helps prevent complications and ensures faster recovery.
Living with croup
Managing croup as an adult involves more than just treating acute symptoms. It requires an ongoing commitment to respiratory health and awareness of potential triggers and risk factors.
Monitoring symptoms
Track your symptoms and any changes in your condition. A symptom diary can be useful for recording the severity and frequency of cough, breathing difficulties, and other related issues. This information is valuable for your healthcare provider when adjusting your treatment plan.
Environmental control
Limit exposure to potential irritants that could aggravate your symptoms. This includes avoiding smoke, dust, and strong fumes. Use air purifiers at home to keep the air clean and maintain a comfortable humidity.
Regular check-ups
Regular check-ups with your healthcare provider help monitor your respiratory health. Early detection of changes or complications leads to more effective treatment and management.
Support system
A strong support system can significantly aid in managing croup. This includes family, friends, or support groups that understand your condition and provide emotional and practical support.
Summary
Croup in adults, although less common than in children, can lead to serious complications if not treated promptly. Understanding symptoms, potential complications, and treatment options is essential for effective management. Through these preventive measures and seeking prompt medical care, adults can reduce the risk of severe croup. Stay informed, stay healthy, and do not hesitate to seek medical advice when needed.
Staying proactive and vigilant helps adults with croup manage their condition effectively and lead a healthy life. Remember that early intervention and proper care are the keys to preventing complications and ensuring a smooth recovery.
References
- Cherry JD. Clinical practice. Croup. N Engl J Med. 2008;358(4):384-91. doi:10.1056/NEJMcp072018.
- Caruthers RL, Lapidus N, Korgenski K, et al. A population-based study of pediatric croup hospitalizations and the role of weather. Pediatr Infect Dis J. 2006;25(10):813-7. doi:10.1097/01.inf.0000232700.43546.9e.
- Denny FW, Murphy TF, Clyde WA Jr, et al. Croup: an 11-year study in a pediatric practice. Pediatrics. 1983;71(6):871-6.
- Johnson DW. Croup. Clin Evid. 2004 Jun;(11):2925-35.
- Marx A, Torok TJ, Holman RC, et al. Pediatric hospitalizations for croup (laryngotracheobronchitis): biennial increases associated with human parainfluenza virus 1 epidemics. J Infect Dis. 1997;176(6):1423-7. doi:10.1086/514126.
- Zoorob R, Sidani MA, Fremont RD, et al. Croup: an overview. Am Fam Physician. 2011;83(9):1067-73.
- Manach Y, Bedwani R, Suresh S, et al. Complications of croup. Anaesthesia. 2017;72(7):872-7. doi:10.1111/anae.13907.
- Johnson DW. Croup: an overview. Am Fam Physician. 2008 Apr 1;77(7):1001-8.
- Bjornson CL, Johnson DW. Croup in children. CMAJ. 2013 Oct 1;185(15):1317-23. doi: 10.1503/cmaj.130645.
- Orr JE, Malhotra A. Pathogenesis of sleep apnea: When upper airway function gets in the way. Sleep Med Clin. 2014 Mar;9(1):1-11. doi: 10.1016/j.jsmc.2013.10.003.
- Braden B, Luebbers C, Sterkers O, Tardivel D. Acute laryngitis and vocal fold inflammation. Lancet. 2003 Jan 25;361(9352):164-6. doi: 10.1016/S0140-6736(03)12220-1.
- Pulmonary edema: pathophysiology and diagnosis. Herold CJ, Sode BF, Fuld MK, Gefter WB, Hamedani H, Rahaghi FN, Chon D, Torres G, Saba OI, Moghadamfalahi M, Parraga G, Roberts HR, Cooper JD, Ross JC, Estepar RS, Washko GR, Hatabu H. Am J Respir Crit Care Med. 2014 Sep 15;190(6):611-7. doi: 10.1164/rccm.201402-0403CI.
- Juergens UR, Stöber M, Vetter H. The anti-inflammatory activity of eucalyptol (1.8-cineole) in bronchial asthma: a double-blind placebo-controlled trial. Respir Med. 2003 May;97(3):250-6. doi: 10.1053/rmed.2003.1472.
- Raudenbush B, Koon J, Cessna T. Effects of peppermint odor on lung function and exercise performance. J Sport Med Phys Fitness. 2001 Mar;41(1):10-4.
- Bergman P, Lindh ÅU, Björkhem-Bergman L, Lindh JD. Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS One. 2013 Jun 19;8(6):e65835. doi: 10.1371/journal.pone.0065835.
- Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al-Ansary LA, Bawazeer GA, van Driel ML, Nair S, Foxlee R, Rivetti A. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD006207. doi: 10.1002/14651858.CD006207.pub4.