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Lung diseases

Cough

01/06/2011

Question:

Every time I get the flu or a cold at the end I get this realy bad barking cough. My friends say that I sound like a seal. I am 37 years old and last year my doctor told me that I had bronchitis 4 times. Once I went to the ER with the cough and they said that it sounded like I had croup. What can you tell me about croup in adult? How does that happen? Is it common? Any way to prevent it? How can I tell if it is bronchitis, croup or just a cough from the cold?

Answer:

I am limited in my ability to answer this question since the diagnosis of croup is a clinical diagnosis which requires exam and observation. Evaluation by your physician is needed to decide if indeed this is a diagnosis which applies to you. I can only talk in general terms about "croup".

The term croup has been applied to describe a number of upper respiratory conditions, usually in children, including laryngitis, laryngotracheitis, laryngotracheobronchitis, bacterial tracheitis, or spasmodic croup (N Engl J Med. 2008;358(4):384-91). In the past, laryngeal diphtheria (diphtheritic or membranous croup) has also been considered as a cause but is now uncommon. 

The symptoms which typically define croup are inspiratory stridor, cough, and hoarseness. These symptoms result from inflammation, irritation and swelling in the larynx and upper trachea (windpipe). The “barking” cough is frequently described as the hallmark of croup and typically seen in infants and young children. This kind of process and inflammation can worsen to respiratory difficulty given the small diameter of airways in children. Although adults can have these symptoms as well, “hoarseness” is more common and respiratory compromise is uncommon. 

The most common cause of croup is a virus, such as parainfluenza virus, adenovirus or respiratory syncytial virus (RSV). These are the same viruses which commonly cause colds and bronchitis and are spread by droplets in the air or on surfaces from people who have an infection. Some of the best ways to prevent virus respiratory infections (especially in the fall and winter in North America) is by frequent hand washing and avoidance of ill contacts. As can be seen from the definitions above, croup is really a descriptive term of a respiratory infection which leads to extra symptoms of a characteristic cough or hoarseness. Respiratory infections (colds and bronchitis) can lead to these extra symptoms so that distinguishing between cold, bronchitis or croup may not practically be as useful as considering if/what additional therapies may be needed in the setting of a respiratory infection. (i.e. Antibiotics if a bacterial cause is suspected or treatment of airway narrowing or wheezing with anti-inflammatory therapies if present and significant). These are therapies which your physician can help decide upon. Some patients with asthma or a predisposition of asthma may be more likely to develop croup. Your doctor can help decide if you may be one of these individuals. I hope this is helpful.

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Response by:

Robert  Schilz, DO, PhD Robert Schilz, DO, PhD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University