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Adult Onset Asthma

Although many people first develop asthma during childhood, asthma symptoms can occur at any time in life. This fact sheet provides general information about the nature of asthma when it appears in adults for the first time. We hope that the material helps you better understand what adult onset asthma is and how you can best manage it. Please keep in mind that this information is not meant to take the place of medical advice from your own physician.


When 53-year-old Dorothy had the flu, it took her weeks to get over it. Afterwards, she still felt winded just doing her everyday routine. Sometimes she had tightness in her chest that made her wonder if she was starting to have heart problems. At night, she noticed it was easier to breathe propped up a little bit. Finally, she talked with her physician about her symptoms. An in-office breathing test helped determine that Dorothy had asthma and her heart was just fine.


What is adult onset asthma?

Asthma symptoms can appear at any time in life. People can develop asthma at age 50, 60, or even later. Adults who develop asthma are said to have adult onset asthma.


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.


What is asthma?

Asthma is a disease of increased responsiveness of the airways to various stimuli including allergens and irritants that cause obstructions of the airways. Constriction of muscles around the airway and inflammation result in swelling of the lining and increased secretion of mucous. This causes difficulty in breathing and coughing. The most common causes of an asthma flare up are infection, exercise, allergens, and air pollution (an irritant). People who have asthma may experience wheezing, coughing, shortness of breath, and chest tightness. Asthma can begin at any age but with proper management and education, people with asthma can lead normal, active lives.


Who gets adult onset asthma?

Several factors may make a person more likely to develop adult onset asthma. Women are more likely to develop asthma after age 20. Obesity appears to significantly increase the risk of developing asthma as an adult. Individuals who had asthma as a child may see asthma recur later in life.


What causes adults to develop asthma?

At least 30% of adult asthma cases are triggered by allergies. People who are allergic to cats may have an increased risk for developing adult onset asthma. Exposure to allergens or irritants such as cigarette smoke, chemicals, mold, dust, or other substances commonly found in the person’s environment (e.g. home or work place) might trigger the first asthma symptoms in an adult.

Prolonged exposure to certain workplace materials may set off asthma symptoms in adults.

Hormonal fluctuations 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.

Different illnesses, viruses, or infections can be a factor in adult onset asthma. A bad cold or a bout with the flu is often a factor in adult onset asthma.

Smoking does not cause adult onset asthma; however, if you smoke or if you are exposed to cigarette smoke (second-hand smoke), it may provoke asthma symptoms.


Can asthma reappear in adults after disappearing years ago?

Asthma is usually diagnosed in childhood. In many patients; however, the symptoms will disappear or are significantly reduced after puberty. After 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, you should continue to avoid your known triggers and keep your “rescue” medications or prescriptions up-to-date and handy in case you need them.


What are signs and symptoms of adult onset asthma?

Regardless of age, asthma symptoms can include:

•            Dry cough, especially at night or in response to specific “triggers”

•            Tightness or pressure in the chest

•            Wheezing — a whistling sound — when exhaling

•            Shortness of breath after exercise or physical exertion

•            Difficulty breathing

•            Colds that go to the chest or “hang on” for 10 days or more


How is the condition diagnosed?

To diagnose asthma, your physician will question you about your symptoms, perform a physical exam, and conduct lung function (breathing) tests. You also may be tested for allergies.

Your internist or family physician may refer you to an allergist or pulmonologist (who specializes in lung diseases) for specialized testing or treatment.

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 permanent loss of lung function. If you have any asthma symptoms, don’t ignore them, and don’t try to treat them yourself. Get a definitive diagnosis from your health care provider.


Asthma symptoms can mimic other illnesses or diseases especially in older adults. For example:

  • Hiatal hernia, stomach problems, heart failure, or rheumatic 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.


How can adult onset asthma be managed?

If you manage your asthma, you can expect to lead a normal lifestyle. Basically, there are four key steps to managing asthma successfully:

1.   Learn about asthma and stay up-to-date on new developments.

2.   Take prescribed medications. Don’t make any changes until you check with your physician. Don’t use over- the-counter medications unless prescribed by your physician!

3.   Check your lungs daily at home by using a peak flow meter. Asthma patients often can detect lung changes with a peak flow meter before they actually experience any changes. Visit your physician regularly for further in-office tests. Lung testing is painless and provides valuable data that helps your physician make adjustments in your medication.

4.    Make an asthma management plan with your physician. A plan establishes guidelines that tell you what to do if your asthma symptoms get worse.


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 the pollen count or ozone level is 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.


In order to determine relevant triggers, you may want to seek consultation with an allergist who can further define these triggers.

In addition, anyone with asthma should consider getting an annual flu shot. Older adults also should talk with their internist about getting a pneumonia vaccination.


What kind of physician treats adult onset asthma?

Many older patients are treated for asthma by their internist or family physician; however, if your asthma symptoms are not under control within three to six months, or if you have severe persistent asthma, or if you are having asthma episodes that need emergency treatment, it may be time to see an asthma specialist. Allergists/Immunologists or pulmonologists (who specialize in the treatment of lung diseases) are specialists who treat asthma. Those who have completed training in those specialties are usually called board-certified or board-eligible.


What is the best way to live with asthma?

The key to good living with asthma is developing a strong partnership between patients, caregivers, and physicians. Practical steps include the following:

•   Make an asthma care management plan with your physician. An asthma management plan helps you understand what to do when specific situations arise. Each time you visit the physician, talk about your plan, and make any necessary changes.

•   Educate yourself. Stay informed about the latest developments in asthma and allergy care and treatment. Ask your physician about new medications or research findings that may relate to your care. (Don’t make any changes to your asthma care plan without discussing them with your physician.)

•   Get regular medical care. If you have asthma, you should see your physician at least once a year, even if your symptoms are under control. When you become sick, or if you have significant changes in your health, you should also talk with your physician about how your asthma could be affected.

•   Take your medicine. Your asthma medications will make you feel better and sometimes people think that’s the time to stop. It’s not! Use your medications as prescribed.

With good management, asthma symptoms can be controlled. Most people who develop adult onset asthma are able to lead normal lives. Expect success!


Are there any special considerations for adults who develop asthma?

People with multiple medical conditions need to be aware of how their illnesses and the medications they use may affect one another.

If you take more than one medication, talk with your physician about ways to simplify your medication program. 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 or herbal supplements.


Be aware of medication side effects:

• Some asthma and allergy medications can increase your heart rate.

• Oral steroids sometimes prescribed for hard to control asthma can make symptoms of glaucoma, cataracts, and osteoporosis worse.

• Beta-blocking medications can worsen asthma.


Does health insurance cover asthma treatment?

Most health insurance plans provide some level of coverage for asthma patients. Check with your insurance carrier for details. Some things you may want to find out might include:

  • Do you need a referral to an asthma/allergy care specialist from your internist or family physician?
  • Does the insurance carrier offer any patient education or specialized services related to asthma?
  • If you had asthma when you were younger and are now experiencing adult onset asthma, does the insurance provider consider this a pre-existing condition? If so, what coverage is offered for pre- existing conditions?
  • What medications are not covered by your plan? (There can sometimes be a delay in approving newly released medications. Your physician may know about them, but your insurance may not cover them yet.)
  • Is a flu shot covered as part of asthma care? A pneumonia vaccine?


The information provided in this fact sheet should not be a substitute for seeking responsible, professional medical care.


Reprinted with permission from “Asthma and Allergy Answers,” the patient education library developed by the Asthma and Allergy Foundation of America.