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Croup in Adults: Symptoms and Treatment

Croup in adults is a rare inflammation of the larynx and upper airways causing hoarseness, a barking cough, and breathing difficulties. Learn about causes and treatment.

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Croup in adults is a rare inflammation of the larynx and upper airways causing hoarseness, a barking cough, and breathing difficulties. Learn about causes and treatment.

What is Croup in Adults?

Croup (also known as laryngotracheitis or stenosing laryngotracheitis) is an inflammation of the larynx and trachea, most commonly triggered by viral infections. While croup primarily affects young children between six months and six years of age, adults can occasionally develop the condition as well. In adults, the presentation is often atypical, which can make diagnosis more challenging.

Causes

In adults, croup is most often caused by viral infections. The most common pathogens include:

Parainfluenza viruses (types 1 and 2) – the leading cause
Influenza viruses
Respiratory syncytial virus (RSV)
Adenoviruses
SARS-CoV-2 (COVID-19, as a rare complication)

In adults, additional contributing factors may include:

Allergic reactions (allergic croup)
Gastroesophageal reflux disease (GERD)
Inhalation of irritants or pollutants
Immunodeficiency or pre-existing respiratory conditions

Symptoms

The symptoms of croup in adults resemble those in children but may be less severe or present differently. Common complaints include:

Barking cough – the hallmark symptom of croup
Hoarseness or loss of voice
Inspiratory stridor – a high-pitched, wheezing sound when breathing in
Shortness of breath (dyspnea), especially during physical activity
Sore throat and difficulty swallowing
Low-grade fever
General malaise and fatigue

Because adults have larger airways than children, life-threatening airway obstruction is uncommon. However, severe breathing difficulties or pronounced stridor should always be evaluated by a physician promptly.

Diagnosis

Diagnosis is typically based on a combination of clinical examination and medical history. The following investigations may be used:

Laryngoscopy: Direct visualization of the larynx to assess swelling and inflammation
Imaging: X-ray or CT scan of the neck and chest to rule out other causes (e.g., epiglottitis, foreign body)
Laboratory tests: Full blood count, inflammatory markers (CRP, white blood cells), and viral detection if indicated
Pulse oximetry: Measurement of blood oxygen saturation

It is important to distinguish croup from similar conditions such as epiglottitis, angioedema, or diphtheria, all of which can also cause breathing difficulties and may be life-threatening.

Treatment

Treatment of croup in adults depends on the severity of the condition:

Mild to Moderate Cases

Corticosteroids (e.g., dexamethasone, budesonide) – reduce mucosal swelling and are the cornerstone of medical treatment
Inhalation of cool or humidified air – may provide symptom relief
Adequate fluid intake and physical rest
Antipyretics (fever-reducing medications) such as paracetamol or ibuprofen for fever

Severe Cases with Marked Breathing Difficulties

Nebulized epinephrine (adrenaline) – acts quickly to reduce airway mucosal swelling
Supplemental oxygen if blood oxygen levels are low
Hospital admission for monitoring and supportive care
In very rare, extreme cases: intubation or tracheotomy

Treating the Underlying Cause

If a bacterial superinfection is confirmed, antibiotics are prescribed. Antiviral medications are used only for specific viral infections, such as influenza.

Prognosis and Course of Disease

In adults, croup is usually a benign condition that resolves within a few days to two weeks. The risk of serious complications is lower in adults than in young children. Nevertheless, individuals with pre-existing respiratory conditions, weakened immune systems, or severe breathing difficulties should seek medical attention without delay.

When to See a Doctor

Adults should seek immediate medical attention if they experience:

Severe or worsening shortness of breath
Clearly audible stridor at rest
Bluish discoloration of the lips or fingernails (cyanosis, indicating oxygen deficiency)
High fever above 39 °C (102.2 °F)
Difficulty swallowing or drooling (possible sign of epiglottitis)

References

Bjornson CL, Johnson DW: Croup in children. In: CMAJ. 2013;185(15):1317-1323. DOI: 10.1503/cmaj.121645
Zoorob R, Sidani MA, Fremont RD, Kihlberg C: Croup: an overview. In: American Family Physician. 2011;83(9):1067-1073.
World Health Organization (WHO): Acute Respiratory Infections. Available at: www.who.int

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