What Is Adult Onset Asthma?

When Asthma Symptoms Appear Later in Life

Table of Contents
View All

Adult onset asthma is simply defined as asthma that appears once you are an adult. However, there are distinct differences between adult onset asthma and the type of asthma that commonly occurs in childhood.

Asthma is a breathing disorder where inflammation of the airways and lungs can cause them to constrict which limits the amount of airflow and causes symptoms such as difficulty breathing and wheezing.

Asthma is commonly associated with triggers such as allergies, exercise, or inhaled chemicals. The symptoms of asthma may manifest at any age, and adults who first experience symptoms of asthma later in life are more common than you think.

adult using asthma inhaler
Close up of older Hispanic woman using inhaler. Terry Vine / Getty Images

Characteristics

Adult onset asthma is recognized as a specific and separate subtype of asthma, first recognized around 1940, and has different characteristics than other types of asthma. Adult asthma occurs in approximately 12 out of every 1,000 individuals. It is more common in women than in men and more common in individuals who are obese.

Some of the characteristics of adult onset asthma include that it is less likely to result in periods of remission and breathing symptoms are more constant rather than intermittent. It also tends to result in more rapid decline in lung function than other types of asthma.

Unfortunately adult asthma can be more difficult to treat than childhood cases. About 30% of adult onset asthma is associated with allergies.

Adult Onset Asthma Symptoms

Symptoms of adult onset asthma are similar to those of other types of asthma but are less likely to wax and wane in periodic episodes than the symptoms of childhood asthma. The following symptoms may occur:

  • Coughing
  • Wheezing (a characteristic breathing sound that is made on exhalation)
  • Difficulty breathing
  • Chest pain or tightness
  • Chest infections such as colds that take a longer time to clear up than is typical

Symptoms may be constant or may get worse when you are exposed to certain "triggers." Common allergy triggers include allergens (pollen or pet dander), chemicals such as cigarette smoke or toxins that you may be exposed to as part of your job (paint fumes, cleaners, and more), or exercise.

Causes

The exact causes of adult onset asthma are not necessarily always known. We do know that while it can be associated with allergies, this is less common in adult onset asthma than in asthma that occurs in childhood. The biggest trigger for adults tends to be cat dander.

Chronic rhinitis, another associated condition has also been linked to adult onset asthma. Respiratory infections are also thought to be a trigger or to bring on adult onset asthma.

Adult onset asthma is more common in adult females. There is evidence that it is specifically linked to female sex hormones. 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.

Irritant exposure in the workplace or environmental pollutants including cigarette smoke are other factors that may result in adult-onset asthma. Medications that have been linked to asthma include aspirin and acetaminophen.

Diagnosis

If you suspect adult onset asthma it is important to see a physician. Your doctor will ask you questions about your symptoms, health history, family history, and any potential triggers that seem to make your symptoms appear or get worse. This is usually followed by a physical exam including auscultation of your lungs (listening to them with a stethoscope).

Asthma is usually diagnosed based on the results of breathing tests called pulmonary function tests (PFT). There are different types of PFT's including spirometry, peak expiratory flow (PEF), and fractional exhaled nitric oxide (FeNO). These tests typically involve simply inhaling or exhaling into a handheld device and not generally uncomfortable. 

Treatment

Although they still may be used, unlike childhood asthma adult onset asthma doesn't respond as well to treatment with corticosteroids and beta-2 agonists. It is better treated based on the most likely cause or risk factor responsible for its onset.

For example, if the problem is an allergy avoiding that particular allergen would be a form of treatment. If your asthma is hormone related you may benefit from discontinuing oral contraceptives. If your asthma was brought on by the use of aspirin or acetaminophen you should stop taking these medications.

Medications

Inhaled corticosteroids may be used to prevent asthma attacks despite being somewhat less effective in this type of asthma. In some cases, inhaled corticosteroids may be temporarily replaced or supplemented with oral steroids in order to reduce severe inflammation.

Short acting bronchodilators may be prescribed as a rescue medication to relieve an acute asthma attack. One of the most commonly used short acting bronchodilators is albuterol.

Theophylline is a smooth muscle relaxer that can cause bronchial dilation. It is taken as an oral tablet at regular intervals to prevent asthma attacks.

Montelukast is a leukotriene receptor antagonist used to prevent asthma attacks like theophylline it is taken as an oral tablet at regular intervals. If montelukast is not a good option for you other leukotriene receptor antagonists may be used.

Biologics may be used for the treatment of adult onset asthma to modify or block certain components of the immune system and thereby reduce the severity of the immune response that is causing asthma symptoms. Specifically monoclonal antibodies are used.

These medications are extremely expensive, however, and therefore their use may be limited. Examples of biologic medications that have shown promise in the treatment of asthma include Xolair (omalizumab), Nucala (mepolizumab), and lebrikizumab.

Bronchial Thermoplasty

Bronchial thermoplasty is an outpatient surgical procedure performed like a bronchoscopy in which thermal energy is used to reduce the amount of muscle in the airways that can constrict during an asthma attack. It must be performed three times to address different areas (lobes of the lungs) at least three weeks apart.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Asthma and Allergy Foundation of America. Adult onset asthma.

  2. de Nijs SB, Venekamp LN, Bel EH. Adult-onset asthma: is it really different? Eur Respir Rev. 2013;22(127):44-52. doi:10.1183/09059180.00007112

  3. Global Allergies and Airways Patient Platform. Adult-onset asthma: Causes, symptoms, treatment and management.

  4. Barnes PJ. TheophyllineAm J Respir Crit Care Med. 2013;188(8):901-6. doi:10.1164/rccm.201302-0388PP

  5. MedlinePlus. Montelukast. Updated May 15, 2020.

  6. Cleveland Clinic. Bronchial thermoplasty.