Does Croup Affect Older People? Understanding Adult Croup

While most people associate croup with young children, a 2017 review of medical literature highlighted cases of adult croup, suggesting it can and does affect older people. The virus that causes croup is contagious and can infect adults, though its manifestation is often more severe in the rare instances it progresses beyond common cold symptoms.

Quick Summary

Croup is an upper respiratory infection that rarely affects adults, including older people, due to larger airways. When it does occur, it can be more severe, often requiring hospital care. Symptoms can include a barking cough, hoarseness, and noisy breathing (stridor).

Key Points

• Rare in adults, but possible: While typically a childhood ailment, adults, including older people, can be infected with the viruses that cause croup, though it occurs infrequently.

• Adult symptoms can be more severe: When adults do develop croup, it often presents as a more serious illness requiring aggressive treatment and potentially hospitalization, unlike the mild cases commonly seen in children.

• Larger airways offer protection: Adults have larger, more rigid windpipes, which prevents the significant airway narrowing that causes the classic barking cough and stridor in most cases.

• Viral causes are the same: The viruses responsible for croup in children, such as parainfluenza and RSV, also cause the rare cases seen in adults.

• Treatment involves steroids and epinephrine: Adults with severe croup are often treated with corticosteroids to reduce inflammation and nebulized epinephrine for airway swelling.

• ICU admission is a possibility: Reported cases of adult croup frequently involve admission to the Intensive Care Unit (ICU) for close monitoring and respiratory support.

• Prognosis is good with proper care: With prompt medical attention, older adults with croup can expect a full recovery, although the illness and recovery period may be more prolonged than in children.

Understanding Croup: A Rare Occurrence in Older Adults

Croup, also known as laryngotracheitis, is an infection causing inflammation and swelling of the voice box and windpipe. While notoriously common in young children aged six months to three years, it is a rare phenomenon in adults, particularly older individuals. The key difference lies in anatomy: adult airways are larger and more rigid, making them less susceptible to the significant narrowing that produces the hallmark symptoms of childhood croup. However, when an adult, including an older person, does contract the infection, the consequences can be more serious and require aggressive medical management.

The Viral Culprits Behind Adult Croup

The infectious agents responsible for adult croup are typically the same viruses that cause it in children. The most common of these is the parainfluenza virus. Other viruses that can lead to adult croup include:

• Respiratory syncytial virus (RSV)
• Influenza virus
• COVID-19
• Rhinovirus (the common cold virus)

An adult may contract these viruses from a child who has croup or through general exposure to respiratory droplets. For most adults, these viral infections result in common cold or laryngitis symptoms. It is only in rare cases that the inflammation progresses to cause the characteristic croup symptoms.

Symptoms and Diagnosis in Older Adults

Symptoms of croup in older adults may begin with mild, cold-like signs, but progress over a few days. This transition can be a critical indicator for healthcare providers. Initial symptoms may include a runny nose, sore throat, or fever, before the more severe respiratory signs appear.

Common symptoms in adults include:

• Barking cough: A deep, hoarse cough resembling a seal's bark.
• Hoarseness: A change in voice or complete loss of voice.
• Stridor: A high-pitched, noisy or whistling sound when breathing in.
• Difficulty breathing: Shortness of breath or labored breathing.
• Fatigue: Generalized tiredness.

To diagnose croup in an older adult, a doctor will typically perform a physical examination, listening to the lungs and evaluating breathing sounds. In many cases, additional tests are required to rule out other, potentially more serious conditions with similar symptoms, such as epiglottitis or bacterial tracheitis. A chest X-ray can reveal subglottic narrowing, a classic sign of croup, and a laryngobronchoscopy (an internal view of the airway) might also be used.

Comparing Croup in Children and Older Adults

While the underlying infection may be the same, the experience and management of croup differ significantly between children and older adults. The comparison table below highlights these key distinctions.

Characteristic	Croup in Young Children	Croup in Older Adults
Incidence	Very common, especially between 6 months and 3 years.	Rare, though possible.
Airway Anatomy	Smaller, more flexible airways, prone to significant narrowing.	Larger, more rigid airways, making significant swelling less likely.
Severity	Generally mild and often treatable at home, although severe cases can occur.	When it occurs, it tends to be more severe, often requiring aggressive management and hospital admission.
Hospitalization	Only 1 to 8% of cases require hospital admission.	Up to 87% of reported adult cases required Intensive Care Unit (ICU) admission.
Treatment Needs	A single dose of steroids is often sufficient for moderate-to-severe cases.	More aggressive treatment, including multiple steroid doses and nebulized epinephrine, is common.
Duration of Stay	Most hospitalized children recover and go home within 24 hours.	Hospitalization is often longer, with some cases requiring an artificial airway.

Treatment and Prognosis for Adult Croup

As with children, there is no cure for the viral infection causing croup, but treatment focuses on managing symptoms and supporting breathing. Given the greater severity, adults with croup often require aggressive medical intervention in a hospital setting, sometimes even in the Intensive Care Unit (ICU).

Treatment for adults may include:

• Steroids: Medications like dexamethasone are used to reduce inflammation and swelling in the airways.
• Nebulized Epinephrine: This can provide temporary relief from airway swelling.
• Supplemental Oxygen: Used to help adults breathe easier when the windpipe is swollen.
• Humidified Air: While not proven to reduce severity, it can offer some comfort.
• Rest and Hydration: Standard supportive care measures are essential for recovery.

For most adults, the prognosis is excellent with prompt and appropriate medical care, with symptoms typically resolving within a week or longer. However, the illness requires careful monitoring due to its potential for serious respiratory complications.

Conclusion: A Rare, but Serious Concern

Does croup affect older people? The answer is yes, but it is a rare and distinct clinical entity compared to childhood cases. The larger, more rigid airways of adults generally prevent the development of the characteristic barking cough and stridor associated with the illness in children. However, when it does occur, adult croup is often more severe and necessitates a higher level of medical care, including possible hospitalization and intensive treatment. For older adults experiencing cold-like symptoms that progress to a harsh, barking cough, hoarseness, or difficulty breathing, immediate medical evaluation is crucial to ensure a positive outcome.

Visit the CDC's website for more information on respiratory viruses that can cause croup.

Frequently Asked Questions

Why is croup so rare in older people?

Croup is rare in older people because their airways are larger and more developed than those of young children. This means the inflammation and swelling caused by the virus do not typically result in significant airway narrowing, which is the cause of the characteristic croup symptoms.

What is the primary cause of croup in older adults?

The primary cause is a viral infection, most commonly by parainfluenza viruses. Other potential viral causes include Respiratory Syncytial Virus (RSV), influenza, and rhinoviruses, which can be easily contracted from an infected child.

What are the key symptoms of croup in an older adult?

The classic symptoms of croup in adults include a deep, harsh barking cough, hoarseness, and inspiratory stridor (a high-pitched whistling sound when breathing). It may also be preceded by common cold symptoms like a runny nose and fever.

Is adult croup more severe than childhood croup?

Yes, when it occurs, adult croup tends to be more severe than childhood croup. Medical literature shows adult cases often require more aggressive treatment, longer hospital stays, and more frequently lead to ICU admission.

How is adult croup treated?

Treatment for severe adult croup often involves hospital care, including corticosteroids to reduce inflammation and nebulized epinephrine to relieve airway swelling. Supplemental oxygen and supportive care like hydration and rest are also important.

Can an older person catch croup from a child?

Yes, an older person can catch the virus that causes croup from an infected child. However, due to anatomical differences, they are more likely to experience mild cold-like symptoms rather than the full-blown respiratory distress associated with croup.

How is adult croup diagnosed?

Diagnosis is made by a healthcare provider based on the patient's symptoms, a physical exam, and sometimes additional tests. A chest X-ray may show subglottic narrowing, and an internal view of the airway may be used to confirm the diagnosis.

What is the outlook for older people with croup?

With timely medical intervention, the prognosis for older people with croup is generally good, and a full recovery is expected. However, the illness requires careful management due to the risk of severe respiratory complications.