A dry, hoarse cough, often resembling the sound of a seal, is referred to as a barking cough.

This type of cough more typically happens among children who develop croup, also known as laryngotracheitis. There are only a dozen or so cases of adult croup documents in the clinical literature, from the 1960s to the early 2000s¹. With so few cases, we don't understand the pathological process of croup causing barking cough in adults well.

However, the disease process has some characteristic signs. Adults who have croup often develop a severe disease requiring hospitalization. 

This article will highlight the causes of adult croup along with prevention and treatment strategies for handling barking cough in adults.

What Causes Barking Cough in Adults?

Parainfluenza virus, types 1, 2, and 3, is the most common cause of croup in both children and adults. It accounts for almost 50–80% of infectious croup cases². This virus can easily spread via infectious droplets passing through the air. Coughing, sneezing, speaking, and also breathing can transfer such droplets.

After the parainfluenza virus, the following viruses can also be responsible for croup:

• Influenza virus
• Respiratory syncytial virus
• Rhinovirus
• COVID-19³

On rare occasions, bacteria such as Haemophilus influenzae⁴, Staphylococcus aureus⁵ and Streptococcus pneumoniae⁶can be responsible for causing croup.

Due to the smaller airways and lower immunity strength, children are more likely to develop the classic signs of croup. So, given adults have larger airways, while the infection can spread easily, the disease burden has to be severe to result in classic symptoms of croup in adults.

How Do I Know If I Have Adult Croup?

The initial symptoms of adult croup are similar to those of a common cold⁷. Some of these symptoms can include:

• Fever
• Chest discomfort and congestion
• Runny nose
• Postnasal drip/upper airway cough syndrome
• Fatigue and muscle aches
• Sore throat
• Poor appetite

All of these symptoms may not be present in cases of adult croup, but a combination might be noted during the early stages of infection. Often they might be the only signs of croup, without the characteristic barking cough. 

Once the virus spreads to the rest of the respiratory tract, namely the larynx or voice box, the rest of the throat, and the windpipe, there is an increase in swelling and inflammation. After a few days, classic signs of croup appear. A deep and hoarse croup cough sound is noted, which is similar to a seal barking. Additionally, there may also be changes in your voice, hoarseness, and noisy breathing, also known as stridor⁸.

As the inflammation continues and spreads, it can lead to severe swelling which can result in difficulty breathing and subsequent respiratory distress. Symptoms of croup in adults can be worse compared to children’s and often require medical attention. 

How Is Adult Croup Diagnosed?

When you visit your doctor for a fever and a barking cough, your doctor will conduct a series of tests to identify possible causes for your symptoms. In severe cases of respiratory distress, such as difficulty in breathing and chest discomfort you might consider visiting the emergency department for immediate care.

The initial investigations are usually in your doctor’s office where your physician will look into your throat and listen to your lungs with a stethoscope. 

Basic laboratory tests and imaging tests such as a chest X-ray will be conducted to understand your disease process leading to your barking cough. A characteristic sign of a croup X-ray is “subglottic narrowing.”⁹ This narrowing results from inflammation and edema (trapped fluid) in the larynx reducing the natural space of the respiratory passage. 

Your doctor may consider an internal view of your larynx and upper respiratory tract and this is carried out by laryngobronchoscopy. To confirm a diagnosis, a tracheal aspirate or serological tests¹⁰ are conducted to identify specific organisms.

If you observe your initial symptoms of fever, fatigue, and runny nose progress to a barking cough with difficulty in breathing, it is crucial to consult with your healthcare physician early to prevent severe consequences of croup. Studies have shown that almost 90% of adult croup cases require hospital ICU admission¹¹.

How Is Barking Cough in Adults Treated?

Adult croup caused by viral organisms receives supportive care to reduce the symptoms, as there are no specific medicines prescribed for treatment. Antibiotics do not work on diseases caused by viruses.

If you present to your healthcare facility with severe symptoms such as a barking cough, difficulty taking deep breaths, and chest discomfort they will give you nebulized epinephrine and steroids to reduce swelling and improve your symptoms¹². Since steroids can take a few hours to work, you might need further doses to reduce your swelling. Both these medicines improve the flow of oxygen to your lungs.

In the interim, while the swelling is reducing, you will be supplemented with humidified oxygen. Humidified air is easier to breathe and also allows for better oxygen reach to the lungs and eventually to the bloodstream.

In rare instances, where respiratory distress is severe, a patient may have to be intubated to allow for direct access of air into the lungs. 

You can manage mild-to-moderate symptoms of adult croup at home. Over-the-counter painkillers and prescribed steroids are considered if symptoms do not subside on their own. If you notice your symptoms worsening, consider checking in with your doctor.

Adult Croup Prevention

Prevention strategies for adult croup are similar to any other viral infection. While many adults who get the virus don’t have severe symptoms, and medical literature has documented only a few cases of barking cough in adults, it is still advisable to take precautions to prevent serious illness.

Prevention tips to keep in mind include:

• Staying away from adults and children who appear to be ill.
• Consider wearing masks in enclosed places, especially when interacting with anyone who is sick.
• Wash your hands often and avoid touching your face, nose, and eyes to limit the spread of germs.
• Regularly disinfect the surfaces and countertops in your house.
• Don’t share bottles, straws, and cups with those who have croup.

Alongside these basic prevention strategies, keep a tab on the development of any new symptoms, especially after exposure. Visit your healthcare provider at the earliest opportunity to prevent severe repercussions of adult croup.

Conclusion

Barking cough in adults is rare, but still possible. While medical literature has not documented many cases, most recorded cases have been severe. This essentially means that it is possible most cases of adult croup do not manifest serious symptoms to warrant a specific diagnosis. Adult croup has the potential of causing severe respiratory consequences. While there is no specific treatment available to treat adult croup, there are supportive and life-saving measures that do help to prevent disease progression and aid the body in fighting back. So, if you observe a new onset of fever, changes in your voice, and a barking cough be sure to check in with your doctor.

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Dr. Michelle Frank

Michelle is a healthcare consultant and content creator with over six years of experience in the FemTech space. She contributes extensively to health forums, especially those centered on enabling wellness, advancing digital health, and FemTech solutions. She loves classic rock music, reading classic literature, and finding new spots in town for good food and some chai.