Asthma affects 25 million people in the United States. Approximately 20 million of those affected are adults. Asthma is more common in adult women than men. African Americans, Alaskan Natives/American Indians and Puerto Ricans have higher rates of asthma than other ethnicities.
What is asthma? Asthma is a chronic condition that causes swelling and inflammation in the lungs. It is accompanied by overproduction of mucus and spasm of smooth muscles that control breathing.
Many people are first diagnosed with asthma in childhood, but it can present at any age. Adult-onset asthma is typically defined as asthma that begins any time after the age of 20.
What are risk factors for developing asthma as an adult?
Any adult can develop asthma. However, there are things that may lead people to develop asthma including:
- Family history of asthma
- Allergies
- Smoking
- Obesity
- Significant stress
- Occupational or job-related exposure
- Air pollution
While none of these factors determine if you develop asthma as an adult, they should be considered if you start experiencing symptoms of asthma.
What causes adult-onset asthma?
Adult-onset asthma is often caused by:
- Allergies
- Hormonal changes including pregnancy, menopause and taking estrogen following menopause
- Certain respiratory infections like the cold or flu
- GERD, heartburn and acid reflux
- Environmental irritants including smoke, mold, dust, feather beds and perfumes
It’s also believed that as people age, their immune system becomes more sensitive, opening the door to new allergies.
Asthma can become more serious as people age. This is because adults tend to ignore their asthma symptoms or attribute them to other factors. These factors may include getting older or being overweight or out of shape).
What are asthma symptoms in adults?
Asthma symptoms are the same in both children and adults, however adult asthma is often more persistent.
If you experience any one of the following asthma symptoms, it’s a good idea to speak with your doctor:
- Shortness of breath
- Frequent coughing – especially at night
- Wheezing (a whistling noise during breathing)
- Difficulty breathing clearly
- Chest tightness
Severe asthma symptoms may indicate that you are experiencing an asthma attack.
What is an asthma attack?
An asthma attack when an asthma trigger causes the lungs to become inflamed and swollen.
Symptoms of an asthma attack may include:
- Increased coughing
- Difficulty breathing
- Wheezing or whistling sound
- Chest pain or tightness
If you are experiencing symptoms of an asthma attack, follow your Asthma Action Plan (if you have one). If you don’t have an Asthma Action Plan, talk with your doctor about creating one.
If your asthma symptoms do not improve or get worse, seek emergency treatment. Left untreated, an asthma attack can be fatal.
How is adult-onset asthma diagnosed?
If you have asthma symptoms, schedule an appointment with your doctor who can diagnose adult-onset asthma. There is not one single test or finding on a physical exam that says you have asthma. Rather, your doctor will take in the whole clinical picture to diagnose asthma.
At your appointment, you can expect your doctor to review your symptoms, personal medical history and family medical history. The doctor will also perform a physical exam. After that, the doctor may decide to do additional testing. You may undergo lung function tests, allergy tests, and other tests that may rule in or out an asthma diagnosis.
What are tests used to diagnose adult-onset asthma?
Doctors now have several tools in their toolbox to help diagnose adult onset asthma. Some of these include:
- Spirometry
- Methacholine challenge test
- FeNO (fractional exhaled nitric oxide) test
- Allergy diagnosis and testing
- A test to see how your airways react to exercise
- Tests for related conditions, such as gastroesophageal reflux disease (GERD), obstructive sleep apnea, or sinus disease
- Chest x-ray
Read more about diagnosis and testing here.
What are the different types of asthma?
Asthma is a broad term describing the inflammatory process that causes asthma symptoms. However, there are different types of asthma and treatment may vary depending on the type of asthma you have. These types of asthma are often referred to as phenotypes. There are two main types of asthma:
- Allergic asthma
- Non-allergic asthma (with subtypes including occupational asthma, exercise-induced asthma, asthma-COPD overlap)
Allergic asthma
Allergic asthma is triggered by exposure to an allergen such as pollen, mold, pet dander, or dust mites. This is the most common type of asthma. Treatment involves both addressing allergy symptoms and asthma symptoms.
Non-allergic asthma
Non-allergic asthma may be triggered by a variety of things such as smoke, pollutants, exercise, viruses, extreme weather or stress. Non-allergic asthma often has an older age of onset, is more common in females, and is often more severe than allergic asthma. It is also harder to treat. Occupational or job-related asthma, exercised-induced asthma, and asthma-COPD overlap are all different types of non-allergic asthma.
Occupational asthma
Occupational asthma occurs when symptoms are triggered by occupational exposure to a substance. Some common triggers include chemicals, dust, animal dander and fungi. The National Institutes of Health says workers in the following professions are most at risk:
- Bakers
- Detergent manufacturers
- Drug manufacturers
- Farmers
- Grain elevator workers
- Laboratory workers (especially those working with laboratory animals)
- Metal workers
- Millers
- Plastics workers
- Woodworkers
Treatment focuses on reducing or eliminating exposure to what is triggering symptoms.
Exercise-induced asthma
Exercise-induced asthma is also known as exercise-induced bronchospasm (EIB). Not everyone with EIB actually has asthma. With EIB, airway muscle spasms constrict air flow. This may cause shortness of breath, coughing, wheezing, chest tightness and fatigue. These symptoms usually appear 5-10 minutes after exercise starts or ends. Treatment involves using a quick-relief bronchodilator 10-20 minutes before exercise and if symptoms arise during exercise.
Asthma-COPD (chronic obstructive pulmonary disease) overlap
Asthma and chronic obstructive pulmonary disease (COPD) are two different diseases. When found together, it is referred to as asthma-COPD overlap, or ACO. People with ACO need to have both their asthma and COPD treated. The greatest risk factor for developing COPD is smoking, but occupational exposure can also cause COPD.
How is adult-onset asthma treated?
There is no cure for asthma. Treatment focuses on achieving good asthma control. This includes avoiding asthma triggers and treating asthma with medications. These medications help open the airways, soothe inflammation and prevent symptoms.
Adult-onset asthma can result in a faster decline in lung function. It’s important to speak with your doctor when symptoms arise and follow your treatment plan.
Review with your doctor when and how to properly use a quick-relief inhaler or nebulizer so you know what to do if asthma symptoms emerge.
Develop an Asthma Action Plan with your doctor and learn how to track lung flow at home. Ask about other lifestyle changes that could help control asthma flare-ups. You do not need to limit your activity if your asthma is in control.
As you discuss treatment, be sure to mention if you:
- use beta-blocker medications, as these can increase the severity of asthma;
- have glaucoma, cataracts, or osteoporosis. Some treatments, such as corticosteroids, can interfere with these conditions.
What are asthma triggers?
Common asthma triggers include:
- Indoor allergens: mold, pet dander, dust mites, cockroaches
- Outdoor allergens: pollen, mold
- Irritants: cigarette smoke, diesel exhaust, air pollution
- Respiratory viruses: colds, flu, sinus infections
- Exercise
- Stress
- Cold air or sudden changes in temperature
- Strong smells
- Strong emotions such as laughing or crying
- Hormonal changes
- Humidity
Asthma Medications
Medications play a central role in an asthma treatment plan. They focus on:
- Preventing or reducing airway inflammation
- Interrupting the allergic reaction that triggers symptoms
- Relieving coughing and wheezing, making it easier to breathe
Your doctor will work with you to find the right medicines to manage your asthma. The type of medication and the amount you take will vary based on symptoms and the type of asthma you have. The goal of asthma treatment is to have you feel your best with the least amount of medicine.
It is important for you to get to know your medications. Understand how and why they treat and soothe your lungs and airways. If you’re prescribed an inhaler, make sure you get one with a dose counter. Learn when and how you’re supposed to use your inhaler and follow your treatment plan to better breathing.
Make sure your Asthma Action Plan is updated whenever medications are changed.
What are the types of asthma medications?
There are several different types of asthma medications used in an asthma management plan:
- short-acting (quick-relief) and long-acting bronchodilators relax and open the airways to relieve asthma symptoms such as coughing, wheezing, chest tightness and shortness of breath.
- anti-inflammatory medications reduce and prevent lung inflammation.
- combination medications combine a bronchodilator and anti-inflammatory in one device.
- leukotriene modifiers block the action of leukotrienes, chemicals involved in immune system responses.
- biologics target specific cells and pathways that cause inflammation related to severe asthma.
Your doctor may also prescribe allergy medications to treat any allergy symptoms you may have.
Ongoing adult-onset asthma management
Getting diagnosed with adult-onset asthma may be frustrating or frightening. The goal of treatment is to make you feel better with as little medication as possible. You will need to see your asthma healthcare provider regularly and discuss the effectiveness of treatment.
Worsening or persistent symptoms of asthma may indicate you need an increase or change of medications.
At follow-up appointments, your doctor will:
- review your symptoms;
- do a physical exam;
- do lung function tests and/or FeNO testing.
Make sure to let your provider know if your medications are helping relieve symptoms. With any changes to your treatment, your Asthma Action Plan should also be updated.
Despite plenty of research in recent years, adult-onset asthma is not fully understood.
Talk openly with your doctor about challenges you face. You and your doctor can work together at Shared Decision-Making to manage adult-onset asthma. Collaborate and develop practical, easy-to-implement strategies so you can continue to stay active, healthy and safe.
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