What is Adult Asthma? Causes, Symptoms, and Treatments

Asthma is a chronic lung disease in which swelling and inflammation of the airways in the lungs make it difficult to breathe. While asthma often starts during childhood, it can also begin during adulthood. More than 22 million adults in the US are living with asthma. Adult asthma is when the symptoms of asthma appear when someone is older than 20 years old. Allergies and irritants in the home or workplace are often the causes of adult-onset asthma. Please continue reading to find out the causes, symptoms, and treatment options for adult-onset asthma.

What is the main cause of asthma?

Researchers don’t know what exactly causes asthma, but it is a combination of genetic and environmental factors. We know that exposure to allergens (substances that cause allergies) can trigger asthma. Every person has different triggers for asthma flare-ups. Common asthma triggers include:

Airborne allergens such as pollen, dust mites, mold spores, and pet dander
Air pollutants like smoke and dust
Viral respiratory infections
Physical activity (exercise-induced asthma)
Cold air
Stress and strong emotions
Food additives and preservatives (such as in wine, beer, shrimp, dried fruit, and certain processed foods)

Notably, occupational exposures are the cause of 1 in 6 cases of adult asthma.

What are adult-onset asthma symptoms?

Symptoms of adult-onset asthma are similar to those of regular asthma.

Common symptoms of asthma include shortness of breath (also called air hunger, breathlessness, difficulty breathing, or a feeling of suffocation). Other symptoms during an asthma attack can include chest tightness, frequent coughing, wheezing (a whistling noise), and difficulty sleeping due to asthma symptoms.

Can asthma come on suddenly in adults?

Yes, asthma can come on suddenly in adults. This is called late-onset or adult-onset asthma. In some people, asthma can be present during childhood, then go away for many years, only to come back again during adulthood.

Experts are not sure what exactly causes it, but risk factors for having adult-onset asthma diagnosed include:

A family history of asthma
Being female
Other allergic conditions, such as hay fever or atopic dermatitis
Being overweight or obese
Smoking, vaping, or exposure to second-hand smoke
Exposure to smoke, fumes, air pollution, or chemicals used in certain industries (occupational asthma)
Illnesses such as GERD (gastroesophageal reflux disease)
Certain medications such as aspirin, nonsteroidal anti-inflammatory drugs, and beta blockers

What causes asthma at a later age?

Common reasons for developing asthma at a later age include occupational exposures to dust, fumes, or chemicals (occupational asthma), air pollution, smoking or exposure to second-hand smoke, and obesity. Two main types of asthma are common in adults - eosinophilic asthma (a rare, severe type of asthma that is not linked to allergies and does not respond well to corticosteroids) and aspirin-sensitive asthma (asthma that is made worse by taking aspirin and other nonsteroidal anti-inflammatory drugs and is often associated with nasal polyps and chronic rhinosinusitis).

What are the key differences between childhood asthma and adult asthma?

Gender differences

Asthma in pre-pubertal children is more common in males than females. In contrast, asthma in adults is more common in females than in males. This difference is believed to be due to an increased risk in adult females due to hormonal changes and estrogen treatments, as well as the protective effect of testosterone on the airways in adult males.

Symptoms

Asthma symptoms in children are usually intermittent and often subside when the child enters puberty. Adults tend to have more persistent asthma symptoms and a generally less stable course with more relapses and fewer remissions.

Some of the symptoms of asthma in infants and young children are different from adults, such as poor eating, fatigue, and flaring of the nostrils. Adult-onset asthma is associated with more respiratory symptoms.

The severity of childhood asthma is linked to lung function, the duration of asthma symptoms, and medication use. The severity of adult asthma is associated with lifestyle factors such as smoking and obesity as well as occupational exposures.

Medical management

Adults face additional challenges in achieving good asthma control, for example, due to drug interactions with medications such as aspirin and beta blockers, which can cause asthma-like symptoms or affect how well asthma medicines work.

Mortality

Adults are five times more likely to die from asthma than children. Adult females have a higher risk of death due to asthma compared to adult males.

When to see a doctor?

You should make an appointment to see your physician if you have shortness of breath with minimal to no physical activity, rapidly worsening shortness of breath, frequent coughing or wheezing, or symptoms that interrupt your daily activities or sleep. Severe asthma can be life-threatening and requires emergency treatment. Treating asthma early can prevent permanent lung damage and keep the condition from worsening over time.

How do doctors diagnose adult-onset asthma?

Doctors can make a diagnosis of adult-onset asthma based on the personal and family history, symptoms, physical exam, lung function tests, chest X-ray, allergy testing, and other tests such as a methacholine challenge, sputum eosinophils, nitric oxide test, and provocative testing for cold or exercise-induced asthma.

What is the treatment for adult-onset asthma?

Treatments for adult-onset asthma vary depending on various factors such as age, symptom severity, and asthma triggers. Asthma medications can include the following:

Preventive anti-inflammatory medications

These medications help to reduce airway inflammation and are for long-term use.

Inhaled corticosteroids such as budesonide (Pulmicort Respules, Pulmicort Flexhaler, Rhinocort), fluticasone propionate (Flovent Diskus, Flovent HFA, Xhance), beclomethasone (Qvar Redihaler), fluticasone furoate (Arnuity Ellipta), ciclesonide (Alvesco), and mometasone (Asmanex HFA, Asmanex Twisthaler).
Leukotriene modifiers such as montelukast (Singulair), zileuton (Zyflo), and zafirlukast (Accolate).
Combination inhalers that contain a corticosteroid and a long-acting beta agonist such as fluticasone-salmeterol (Advair HFA, others), formoterol-mometasone (Dulera) budesonide-formoterol (Symbicort), and fluticasone furoate-vilanterol (Breo Ellipta).
Theophylline (Elixophyllin, Theo-24, Theochron).

Quick relief (rescue) medications

These medications quickly open up swollen airways during an asthma attack and can be used before exercise to prevent asthma symptoms.

Short-acting beta agonists such as albuterol (Ventolin HFA, ProAir HFA, others) and levalbuterol (Xopenex, Xopenex HFA). These bronchodilators are available as portable, hand-held inhalers or nebulizers.
Anticholinergic drugs such as ipratropium (Atrovent HFA) and tiotropium (Spiriva, Spiriva Respimat).
Corticosteroids such as prednisone (Rayos, Prednisone Intensol) and methylprednisolone (Medrol, Solu-Medrol, Depo-Medrol).

Allergy medications

These medications are used if asthma is triggered by allergies.

Immunotherapy, also called allergy shots, is given once a week for several months and then once a month for 3-5 years. They desensitize your immune system to specific allergens.
Biologic agents such as mepolizumab (Nucala), reslizumab (Cinqair), omalizumab (Xolair), dupilumab (Dupixent), and benralizumab (Fasenra) for severe asthma.

How to prevent symptoms of asthma?

There is no way to completely prevent asthma. You can achieve good asthma control and prevent frequent asthma attacks with the following asthma action plan:

Asthma treatment

Follow the treatment plan developed by your physician and take your asthma medications at the right dose as prescribed.
Keep all your medical and lab appointments to monitor your asthma.
Call your doctor without delay if you have worsening asthma symptoms, need to use your quick-relief inhaler more often, or don’t get relief from your prescribed asthma medication.
Learn to use a peak flow meter at home to monitor your breathing so that you can identify and treat asthma attacks early.
Stay up-to-date on vaccinations for flu and pneumonia.
Get treatment for diseases such as GERD (acid reflux), if needed.

Asthma triggers

Cover your mouth and nose when going outdoors in cold weather.
Use air-conditioning to reduce exposure to outdoor allergens.
Use a dehumidifier, if needed, and avoid living in a damp environment.
Clean damp areas and remove mold spores from your home.
Keep pets well-groomed to reduce dander.
Decontaminate your home by removing items such as down-filled pillows and feather beds. Use dust-proof covers on mattresses and pillows. Install hardwood floors instead of carpeting. Choose washable blinds and curtains.