What to know about adult-onset asthma

Allergies & Asthma
Adult-onset asthma is asthma that develops in adulthood. In most cases, people develop asthma during childhood, though it can arise at any age.

According to the American Lung Association (ALA), 1 in 12 adults has asthma.

Asthma is a chronic lung disease that leads to problems breathing. It causes narrowing and inflammation of the airways and increased mucus production.

In this article, we provide an overview of adult-onset asthma, including its possible causes, symptoms, and treatments.

Causes

Cigarette smoke can trigger asthma symptoms.
Exposure to cigarette smoke can trigger asthma symptoms.

Doctors are not sure why asthma develops in some adults, but certain factors, such as exposure to chemicals or irritants in the workplace, can cause adult-onset asthma.

According to the ALA, 1 in 6 cases of adult-onset asthma occurs due to occupational exposures. Substances that cause asthma symptoms are called asthmagens.

Adults between 45 and 64 years of age have the highest rates of work-related asthma.

Another possible cause is allergies. Allergies trigger at least 30% of cases of adult asthma.

Various allergens may trigger asthma symptoms in adults. Common allergens include:

  • cigarette smoke
  • some chemicals
  • dust
  • pollen
  • mold


Symptoms

Similar to asthma that develops in childhood, symptoms of adult-onset asthma may include the following:

Adult vs. childhood asthma

Childhood and adult asthma have several similarities, such as symptoms and standard treatment, but there are also differences.

The severity of symptoms can vary in both children and adults.

Asthma that develops in childhood often involves symptoms that come and go. In adult-onset asthma, symptoms are more likely to be persistent and less well controlled.

Adults that develop asthma may have faster lung-function decline that children. Adults, especially by middle age, may have stiffening of the chest wall, which can make treating asthma more difficult.

Adults are also at a higher risk of death due to asthma than children. According to the American Academy of Allergy, Asthma, and Immunology, 3,615 people died due to asthma in 2015. Almost all of these people were over 18 years old.

The reasons why adults have a higher rate of asthma-related death are not clear. It may be because symptoms tend to be less well controlled than children or because of a delay in diagnosis.


Diagnosis

Woman coughing while doctor uses stethoscope to monitor breathing
Adult-onset asthma has similar characteristics to COPD.

it is vital to get an accurate diagnosis of adult-onset asthma in order to develop the most effective treatment plan.

In many cases, adult-onset asthma takes longer to diagnose than asthma in childhood. This is partly due to confusion with other conditions that occur in adults but are rare in children. For example, asthma that develops in adulthood is sometimes confused with chronic obstructive pulmonary disease (COPD).

Doctors can diagnose adult-onset asthma through a physical exam, medical history, and lung-function tests. A lung-function test involves a series of breathing tests that measure how much air a person can inhale and exhale.

Treatment

People can treat adult-onset asthma with a combination of lifestyle changes and medications. Everyone has their own treatment plan with asthma.

Adults are more likely than children to have other medical conditions as well, which is a consideration when developing an asthma treatment plan.

A comprehensive treatment plan often includes:

Bronchodilators

Treatment for most types of asthma includes bronchodilators. Different types of bronchodilators are available, including long-acting and fast-acting ones. Both types can play a role in the management of asthma.

Fast-acting bronchodilators, such as albuterol, work by relaxing the muscles of the airways. As the muscles relax, the airways widen, making breathing easier. People take fast-acting bronchodilators via an inhaler or through a nebulizer. The medications reduce sudden symptoms, such as wheezing and shortness of breath.

People can also use long-acting bronchodilators to manage adult-onset asthma. These drugs also relax the airways, but they last longer than fast-acting inhalers. Instead of treating sudden symptoms, they prevent symptoms.

Corticosteroids

In some instances, people can also use inhalers that contain corticosteroids to treat adult-onset asthma. Steroids decrease airway inflammation.

Inhalers that contain corticosteroids do not treat sudden symptoms. Instead, they decrease the frequency of symptoms.

In some cases, treatment includes oral steroids. However, oral steroids may increase blood sugar levels and possibly worsen other conditions, such as glaucoma and osteoporosis, which can occur in adulthood.

Quitting smoking

One of the most important factors that influences the severity of the disease is cigarette smoking.

A 2014 study looked at the factors affecting asthma severity in 128 adults with new onset of adult asthma.

After two years, researchers assessed changes in asthma severity, using the Global Initiative for Asthma Score. They noticed the following changes:

  • asthma severity increased in 13.3% of the people
  • severity decreased in 41.4% of people
  • cigarette smoking predicted the worsening of symptoms


Day-to-day management

Man with asthma using inhaler.
Being able to recognize and treat a flare-up is important.

Daily prevention of asthma involves taking medications as prescribed. It is also vital to monitor symptoms every day and recognize signs of a flare-up.

Treating symptoms as soon as possible helps get asthma exacerbations under control, preventing life-threatening situations.

Decreasing exposure to lung irritants and allergens is also part of a daily asthma prevention plan.

People may benefit from keeping a daily log of the severity of their symptoms and exposures to different irritants to determine a connection. Reducing exposure to known allergens, as much as possible, helps decrease symptoms.

Risk factors

Certain factors may put a person at an increased chance of developing asthma as an adult:

  • having asthma as a child that disappeared in early adulthood
  • having allergies as an adult
  • hormonal fluctuations, such as those occurring in pregnancy and menopause
  • obesity, which can increase severity of asthma symptoms and risk of hospitalization


Outlook

The outlook for adult-onset asthma varies. Adult-onset asthma can involve more persistent symptoms than in children, which may mean a worse prognosis.

Following an asthma action plan may decrease flare-ups and help people manage the condition. An asthma treatment plan often includes medication and lifestyle changes.

Adults who develop symptoms of asthma should work closely with their healthcare provider to learn more about their condition and management strategies.

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