Adult Onset of Asthma

What is Asthma?

Asthma is a common disease that affects the lungs. About 15 million Americans have asthma. People who have asthma may experience wheezing, coughing, increased mucous production and difficulty breathing. These symptoms are caused by inflammation and/or obstruction of the airways, which transport air from the nose and mouth to the lungs.

What is Adult Onset Asthma?

Many people develop asthma in childhood. However, asthma symptoms can appear at any time in life. Individuals who develop asthma as adults are said to have adult onset asthma. It is possible to first develop asthma at age 50, 60 or even later in life. Adult onset asthma may or may not be caused by allergies. Some individuals who had allergies as children or young adults with no asthma symptoms could develop asthma as older adults. Other times, adults become sensitized to everyday substances found in their homes or food and suddenly begin to experience asthma symptoms. About 50 percent of older adults who have asthma are allergic.

People with asthma may have allergies "triggered" by various allergens. Allergens are substances found in our everyday environment

Who Gets Adult Onset Asthma?

We do not know what causes asthma. There is evidence that asthma and allergy are in part determined by heredity. Several factors may make a person more likely to get adult onset asthma. Women are more likely to develop asthma after age 20. For others, obesity appears to significantly increase the risk of developing asthma as an adult. At least 30 percent of adult asthma cases are triggered by allergies. People allergic to cats may have an increased risk for developing adult onset asthma. Exposure to cigarette smoke, mold, dust, feather bedding, perfume or other substances commonly found in the person's environment may trigger the first asthma symptoms. Prolonged exposure to certain workplace materials may set off asthma symptoms in adults. Hormonal fluctuations and changes in women may play a role in adult onset asthma. Some women first develop asthma symptoms during or after a pregnancy. Women going through menopause can develop asthma symptoms for the first time. An ongoing Harvard Nurses Health Study found that women who take estrogen supplements after menopause for ten years or more are 50 percent more likely to develop asthma than women who never used estrogen. Different illnesses, viruses or infections can be a factor in adult onset asthma. Many adults first experience asthma symptoms after a bad cold or a bout with the flu. Adult onset asthma is not caused by smoking. However, if you smoke or are exposed to cigarette smoke (secondhand smoke), it may provoke asthma symptoms.

What are the Signs and Symptoms of Adult Onset Asthma?

Asthma symptoms can include:

Dry cough, especially at night or in response to specific "triggers"
Tightness or pressure in the chest
Difficulty breathing
Wheezing—a whistling sound—when exhaling
Shortness of breath after exercise
Colds that go to the chest or "hang on" for 10 days or more

How Does Adult Onset Asthma Compare with Childhood Asthma?

Unlike children who often experience intermittent asthma symptoms in response to allergy triggers or respiratory infections, adults with newly diagnosed asthma generally have persistent symptoms. Daily medications may be required to keep asthma under control. After middle age, most adults experience a decrease in their lung capacity. These changes in lung function may lead some physicians to overlook asthma as a possible diagnosis. Untreated asthma can contribute to even greater loss of lung function!

How is Adult Onset Asthma Diagnosed?

Asthma symptoms can mimic other illnesses or diseases—especially in older adults. Hiatal hernia, stomach problems or rheumatoid arthritis can create asthma-like symptoms. Chronic obstructive pulmonary disease (COPD) has many of the same symptoms as asthma. COPD, which includes emphysema and chronic bronchitis, is very common in older adults, especially those who are or have been smokers. To diagnose asthma, your physician will question you about your symptoms, do a physical exam, and conduct lung function tests. In addition, you may be tested for allergies. Your primary care physician may refer you to a pulmonologist (lung specialist) or an allergist for specialized testing or treatment. If you have any asthma symptoms, don't ignore them or try to treat them yourself! Get a definitive diagnosis from your health care provider.

How can adult onset asthma be managed?

There are four key steps to successfully managing asthma:

Learn about asthma and stay up-to-date on new developments
Take prescribed medications. Don't make any changes until you check with your doctor. Don't use over-the-counter medications unless prescribed by your doctor! Check your lungs daily at home with a peak flow meter.
You often can detect changes in your lungs with a flow meter before you actually feel your symptoms increasing. Visit your doctor regularly for further in-office tests. These lung tests are painless and provide valuable data that help your physician make adjustments in your medications.
Make an asthma management plan with your health care provider. A plan establishes guidelines that tell you what to do if your asthma symptoms get worse.

How can Asthma Symptoms be Controlled or Reduced?

If your asthma symptoms are caused by allergies, take steps to control known or potential triggers in your environment. Allergy-proof your house for dust, mold, cockroaches and other common indoor allergens to which you are allergic. Reduce your outdoor activities when pollen counts or ozone levels are high. Choose foods that don't contribute to your asthma or allergy symptoms. Evaluate your workplace for possible allergens and take the necessary steps to reduce your exposure to them.

Can Asthma Reappear in Adults After Disappearing Years Ago?

Asthma is usually diagnosed in childhood. In many patients, however, the symptoms will disappear or be significantly reduced after puberty. Around age 20, symptoms may begin to reappear. Researchers have tracked this tendency for reappearing asthma and found that people with childhood asthma tend to experience reappearing symptoms through their 30s and 40s at various levels of severity. Regardless of whether your asthma is active, continue to avoid your known triggers and keep your rescue medications or prescriptions up-to-date and handy in case you need them.

Are There any Special Considerations for Adults with Asthma?

Many adults take several medications and/or use over-the counter medications, such as ibuprofen or aspirin, regularly. Work with your doctor to simplify your medication program as much as possible. Explore the possibility of combining medications or using alternate ones that will have the same desired effect. Be sure to discuss potential drug interactions with anything you take, including vitamins. Some asthma medications increase heart rate. If you have a heart condition, discuss those side affects with your health care provider. Older "first generation" antihistamines can cause men with enlarged prostates to retain urine. Oral steroids can make symptoms of glaucoma, cataracts and osteoporosis worse. Adults with arthritis may need special inhalers that are easier to operate. Anyone with asthma should consider getting an annual flu shot. Older adults also should talk with their doctor about getting a pneumonia vaccination. People with multiple medical conditions need to be aware of how their illnesses may affect one another.