What Is Adult-Onset Asthma?
Medically reviewed by Daniel More, MD
Adult-onset asthma is a subtype of asthma that develops in adulthood. The symptoms are the same as for asthma that appears during childhood, including dyspnea (shortness of breath) and wheezing, but tend to be more frequent and are more likely to impair lung function.
For this reason, it's important to get a prompt diagnosis so that you can get effective treatment, which typically includes avoiding triggers, using a controller medication regularly to prevent symptoms, and using a rescue inhaler to treat symptoms if they occur anyway.
Verywell / Alex Dos Diaz
Adult-Onset Asthma Symptoms
Symptoms of adult-onset asthma are the same as those of other asthma subtypes. However, in children, symptoms wax and wane, whereas in adults they can be near-constant.
A dry cough, especially at night, when you exercise, or while you're laughing
Wheezing (a whistling sound produced when you exhale)
Difficulty breathing
Shortness of breath, especially after physical exertion
Pain, pressure, or tightness in the chest
Colds that travel to the chest and that linger for longer than is usual (10 days or more)
Related: Signs and Symptoms of Asthma
Causes
The physiology of adult-onset asthma is the same as for all types: In response to exposure to an allergen or other trigger, the bronchi (airways) that provide a pathway for inhaled air to the lungs constrict, or narrow. They also become inflamed due and produce excess mucus. Together, these responses impede the flow of air to the lungs and cause wheezing, labored breathing, and other telltale asthma symptoms.
It isn't fully understood why an individual's lungs might react to an otherwise harmless substance in this way. Experts suspect there is a significant genetic link, given that asthma tends to run in families.
Chronic rhinitis, a bad cold, the flu, and other respiratory infections may set off asthma in adults who have a predisposition to the disease.
Certain allergens are thought to be responsible for about 30% of adult-onset asthma, the most common being:
Exposure to workplace pollutants or toxins (paint, chemicals, and so forth)
Household substances such as dust mites and mold
Cigarette smoke (including secondhand smoke)
Pollen and other allergens
Cat dander
Related: What to Do If You're Allergic to Your Pet
Risk Factors
The risk of developing asthma as an adult is higher in people who are:
Overweight or obese: Inactivity, changes in lung physiology, and inflammation associated with gaining and carrying excess pounds can influence the health of the respiratory system.
Female and over 20: The hormonal fluctuations that take place over the lifetime are associated with adult-onset asthma. The incidence of asthma in females varies depending on the number of children they've given birth to, whether they are in menopause, and whether they are on oral contraceptives or are taking hormone replacement therapy.
Takeaway
People who had asthma as a child that cleared up also can have relapses in their 30s or 40s.
Diagnosis
If you begin wheezing when you breathe in or develop other symptoms that cause you to suspect you have asthma, make an appointment to see your healthcare provider as soon as possible. If you do have asthma, prompt treatment will lower the odds of permanent lung damage.
At your initial appointment the practitioner will ask you detailed questions about your symptoms—when you experience them, what you're doing beforehand, what you may have been exposed to when they develop, and so forth. The healthcare provider will also go over your personal and family health history.
They'll next conduct a physical exam with a focus on auscultation of your lungs (which simply means listening to them with a stethoscope), likely followed by pulmonary function tests (PFTs) to test your lung function and breathing.
PFTs used to diagnose asthma include:
Spirometry: A noninvasive test in which you'll breathe into a simple handheld device to evaluate how much air you can inhale and exhale and how quickly
Peak expiratory flow rate (PEFR): A measurement that reflects how powerfully you can exhale; your PEFR would be normal if it is 80% or greater than what would be predicted
Fractional exhaled nitric oxide (FeNO) testing: A test that indicates the presence of inflammation in the lungs; it is recommended only when spirometry and other diagnostic methods are inconclusive
If your spirometry test is normal, your healthcare provider may perform a bronchodilator responsiveness test or a bronchoprovocation challenge test. For the former, you will be given a medication called a bronchodilator that works by expanding the airways. Ten or 15 minutes later, you'll do a second spirometry test and your practitioner will compare the results to the initial one.
For a bronchoprovocation challenge test, you'll inhale either aerosolized chemicals or cold air, or be asked to exercise, to see if you develop asthma symptoms as a result.
Depending on the results of your initial examination, your healthcare provider may refer you to a pulmonologist (lung specialist) to further evaluate your condition. If it appears your asthma symptoms may be triggered by an allergen, you also may be referred to an allergist for allergy testing.
Learn More: How Asthma Is Diagnosed
Differential Diagnosis
When asthma symptoms appear during adulthood, they can be mistaken for a number of other conditions, among them:
Hiatal hernia, in which the stomach protrudes through the diaphragm
Stomach disorders
Your healthcare provider will likely take these diseases into consideration during the diagnostic process and take measures to rule them out.
Related: The Differences Between COPD and Asthma
Treatment
Managing adult-onset asthma can be more challenging than managing asthma that develops in childhood. For one thing, the lungs and chest walls of older individuals are less flexible and the breathing muscles are weaker.
Asthma medications may be less effective for older adults as well, especially if they're overweight or obese. Oral steroids can worsen common late-in-life conditions, including glaucoma, cataracts, and osteoporosis. Asthma can be more severe in people who are taking beta-blocker medication to treat heart conditions.
That said, adult-onset asthma is best treated by focusing on the cause. If the condition is due to a diagnosed allergy, taking measures to avoid the allergen is key.
Lifestyle Measures
If an indoor allergen such as dust mites or mold is to blame, it is important to mitigate your exposure by taking a multicomponent approach, as recommended by the National Institutes of Health.
This may mean, for example, coping with a dust mite sensitivity by combining use of an air purifier, a vacuum cleaner with a HEPA filter, and covering pillows and mattresses with impermeable covers: Any of these strategies used alone will not be effective enough.
Also important for effective management of asthma is monitoring symptoms and regularly measuring the health of your airways and lungs with peak flow readings and spirometry.
If you smoke, quitting will be vital to managing your asthma. If you have issues with acid reflux, controlling the condition also may help, as will losing weight if you are overweight or obese.
Medications
Asthma medications fall into two broad categories: those taken on regular basis, often daily, to prevent symptoms from occurring (controller medications) and those used in the moment to treat acute asthma symptoms (rescue medications).
Most are taken using an inhaler, which is ideal as this method delivers medication directly to the airways and lungs without risk of affecting other systems in the body.
Controller inhalers for asthma contain corticosteroids that work by preventing airways from becoming inflamed. If inflammation becomes severe, inhaled corticosteroids (ICSs) may be temporarily replaced or supplemented with oral steroids.
Rescue inhalers most commonly contain bronchodilators (medications that expand airways to allow for improved airflow) called short-acting beta agonists (SABAs). The most well-known of these is albuterol, which sometimes is sold under the brand names Ventolin HFA, Proventil HFA, or Proair.
Controller and rescue medications are prescribed based on the severity of a person's asthma.
Takeaway
In January 2023, the Food and Drug Administration (FDA) approved Airsupra (albuterol and budesonide). Airsupra is a combination of a SABA and an inhaled corticosteroid (ICS) for the treatment of acute asthma symptoms and the prevention of future asthma attacks.
Other medications that may be prescribed for adult-onset asthma include:
Theophylline is a medication sold under a variety of brand names that dilates airways by relaxing the smooth muscles that line them. Theophylline is taken orally or intravenously (through a needle into a vein) and is used in conjunction with other medications. It is not as safe or effective as other asthma drugs.
Singulair (montelukast) is in a class of medications called leukotriene receptor antagonists that impact the immune response and help prevent inflammation and mucus production. It is taken orally.
Biologic medications (drugs derived from living organisms) may help treat adult-onset asthma by modifying or blocking certain components of the immune system. For asthma, the type of biologic used are monoclonal antibodies. Examples include Xolair (omalizumab) and Nucala (mepolizumab).
Immunotherapy
Children 5 and older and adults who have mild to moderate allergic asthma may benefit from adding subcutaneous immunotherapy (SCIT)—better known as allergy shots—to their other asthma treatments, according to the NIH.
SCIT works by introducing a known allergen into a person to stimulate a mild immune response. Repeated inoculations at regular intervals will build up this immune response so the body is able to deal with the allergen effectively and normally on its own.
SCIT is recommended as long as asthma stays controlled when the shots are started and remains controlled during subsequent shots.
Related: Living With Asthma and Advocating for Others
A Word From Verywell
Although widely regarded as a childhood disease, asthma can appear at any stage of life. You may find yourself wheezing in your 20s, 30s, 40s, or beyond. Wheezing is never normal, so don't discount it or other asthma symptoms as anything other than a potential breathing condition that should be diagnosed and treated promptly.
When asthma isn't managed, permanent lung damage can occur, What's more, if you happen to have another medical condition, it will likely be exacerbated by asthma. Call your healthcare provider without delay, and you should be able to avoid serious complications.
Read the original article on Verywell Health.
