Adult-onset Asthma: Causes, Symptoms, Treatment and Management

Asthma is a long-term lung condition that affects an estimated 300 million people globally. Over 19 million adults have asthma in the USA (that’s about 1 in 12). In the UK, the number of adults on asthma medication is over 4 million which similarly works out at about 1 in 12 of the adult population.

When you have asthma the inner lining of your airways is sensitive, becomes inflamed and swollen and produces excess mucus. In addition, the smooth muscle surrounding the airways tightens. It results in the airways becoming narrower (a process called bronchoconstriction) making it difficult to breathe in and out.

In the UK, the National Health Service spends £1 billion every year treating and caring for people with asthma. The overall annual cost of asthma to Europe is estimated to be €17.7 billion, while in the US the cost is $80 billion.

What is adult-onset asthma?

Adult-onset asthma is asthma that develops as an adult (usually those over the age of 20), although most people with adult-onset asthma had the condition as a child. For many their symptoms disappeared during their teenage years, but a third of individuals find their asthma returns in adulthood. Some people develop asthma for the first time as an adult – in fact, the condition can develop at any age.

H2 What causes adult-onset asthma?

We don’t know for certain what causes adult-onset asthma but it’s likely to be a combination of environmental, genetic and occupational factors. Your chance of having asthma as an adult is higher if you:

  • Had childhood asthma even if you’ve had no symptoms for several years
  • Are female – more women than men have asthma especially after age 20, around pregnancy and at the menopause so changing hormone levels may play a role here
  • Are exposed to an allergen at work (called occupational asthma) – such as mould, wood dust, chemicals, flour, aerosols and so on). About 15% of all adult asthma is work related
  • Live in poverty
  • Have an allergy, such as hay fever
  • Have a relative who has asthma or an allergy
  • Are overweight – obesity appears to significantly increase the risk of asthma
  • Have an illness or infection, especially a respiratory viral infection.

If you have adult-onset asthma one or more triggers that are individual to you worsen your symptoms, especially if your asthma is poorly controlled, including:

  • Viral infections
  • Some drugs, including beta-blockers, aspirin, ibuprofen and other non-steroidal anti-inflammatory drugs
  • Smoking cigarettes or vaping, car fumes and other air pollutants
  • Allergens at home or work
  • Extremes of weather
  • Exercise
  • Stress or extreme emotions.

Adult vs childhood asthma

It’s common for children to have asthma symptoms that come and go, for example triggered by allergy or a respiratory infection. Adult-onset asthma tends to have persistent symptoms that are often not associated with allergic triggers.

About one in ten adults with asthma have uncontrolled symptoms and exacerbations despite treatment. Such ‘difficult-to-treat’ asthma can reduce quality of life and also lead to more deaths than we see with childhood asthma. We don’t know why adult asthma doesn’t respond as well to treatment as childhood asthma. It may be because adult lungs can be stiff and function less well than a child’s lungs. Also the body’s immune response may change as we get older.

It’s reassuring to remember that death from asthma in adulthood is still uncommon.

Adults also tend to have other illnesses that are affected by asthma and allergy medications. For example oral steroids can worsen the symptoms of glaucoma, cataracts and osteoporosis.

What are the symptoms of asthma in adults?

The symptoms of asthma in adults include:

  • Coughing
  • Wheezing
  • Feeling short of breath
  • Feeling tightness or pain in your chest.

How adult-onset asthma is diagnosed

When considering an asthma diagnosis, your doctor will ask you to:

  • Describe your symptoms and when they happen
  • Explain your family history, workplace, home environment and lifestyle
  • Take one or more breathing (lung function) tests.

Your doctor may also start you on a treatment trial of asthma medication before diagnosis is confirmed.

Asthma symptoms can be confused with some other conditions, especially in older adults. Illnesses that mimic asthma include hernia, gastrointestinal problems, heart disease, pneumonia, rheumatoid arthritis and chronic obstructive pulmonary disease.

Breathing tests for diagnosing adult-onset asthma

The breathing tests for asthma include:

  • Spirometry – how much air you can breathe out in a set time.
  • Bronchodilator reversibility (BDR) – this is when two spirometry tests are done before and after a one-off dose of bronchodilator medication to see if the treatment helps. A positive BDR test usually confirms an asthma diagnosis.
  • Peak expiratory flow (PEF) monitoring – measures how fast you can breathe out. You might be asked to monitor your PEF, often referred to simply as peak flow, at home for two to four weeks.
  • Fractional exhaled nitric oxide (FeNO) – measures the level of inflammation in your airways.
  • Bronchial challenge – investigates how sensitive your airways are to a deliberately administered irritant (histamine or methacholine). This specialist test is only done under medical supervision in hospital.

Most people need just one or two tests to reach a diagnosis. After asthma is confirmed you might have one or more allergy tests to try to identify potential triggers.

Can asthma go away in adults?

There’s no cure for most types of adult asthma. The main exception to this is workplace-related asthma, which can be stopped by identifying and removing the material causing the asthma, or if you remove yourself from the exposure. You may have to change your occupation to do this.

Treatment of asthma in adults

The medications and treatments for adult asthma are:

  • Anti-inflammatories – inhaled corticosteroids are taken daily to prevent asthma symptoms by reducing airway sensitivity and inflammation. Steroid tablets can be taken for acute flare-ups and more severe asthma.
  • Bronchodilators – inhaled short-acting and long-acting bronchodilators are taken occasionally to relieve symptoms. They work within a few minutes and shouldn’t be needed more than three times a week.
  • Leukotriene receptor antagonists – daily tablets to improve prevention if needed.
  • Theophylline – taken daily to prevent symptoms if they are still not well controlled.
  • Monoclonal antibody (Mab) therapy – also called biological medicines or ‘biologics’, these injections block some of the body’s immune response to triggers.
  • Bronchial thermoplasty – is a surgical procedure done on the airway itself to reduce its thickness.

Tips to manage adult-onset asthma

  • Use and follow your Personal Action Plan (PAP), sometimes called an Asthma Management Plan
  • Take your daily preventer inhaler even if you feel fit and well
  • Always keep your reliever inhaler with you
  • Have a review with your doctor or asthma nurse at least once a year
  • Have a seasonal flu vaccine and also pneumococcal vaccine to protect against pneumonia
  • If you smoke, get the help needed to quit
  • Maintain a healthy weight
  • Exercise regularly, eat healthily and get enough sleep. If symptoms arise when exercising – rest, use your reliever inhaler to recover before continuing. Talk to your doctor or asthma nurse if exercise is a trigger for you.
  • Know what to do if symptoms worsen and, if they do, act early.
  • Try practicing breathing exercises for asthma, like the Buteyko method
  • Keep stress levels under control – some people find yoga, mindfulness or massage therapy helpful.

Information and support

You will find a wealth of further information about allergies and asthma on our website, and we hope you will explore it. You can also get in touch with us – we would love to hear from you!