Adult-Onset Asthma: Causes and Treatment

It’s common for childhood asthma symptoms to ease with age. But is the reverse also true? Can you develop asthma as you get older?

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The short answer is: Yes.

For more details, we spoke with pulmonologist Rachel Taliercio, DO. Dr. Taliercio answers common questions about adult-onset asthma.

What is adult-onset asthma?

Adult-onset asthma refers to asthma that you acquire after the age of 20, as opposed to being diagnosed as a child.

“The symptoms of adult-onset and childhood asthma are the same, but they tend to be more severe in adults,” Dr. Taliercio explains. “For example, childhood asthma symptoms are more likely to be milder and well controlled and may improve or disappear with time. Asthma can be more severe, harder to treat and persist if you develop the condition when you’re older.”

Why asthma is more severe in adults

It’s more common to experience asthma symptoms as a child, but adult-onset asthma is usually worse.

One possible reason? Adults are more likely to ignore their symptoms. Life is busy. And it’s easy to assume shortness of breath is a sign that you’re “out of shape,” or that a chronic, dry cough is a normal part of getting older. (It’s not!)

Getting diagnosed with adult-onset asthma — and finding the right therapy — can be a longer process, for reasons we’ll explain in a bit.

“Unfortunately, delays in the diagnosis and treatment of asthma can weaken your lung function,” clarifies Dr. Taliercio. “It’s important to seek medical attention right away if your symptoms suggest you may have developed asthma.”

Adult-onset asthma symptoms also tend to be harder to control. For these reasons, adults with asthma have a higher risk of flare-ups and even hospitalization. In fact, the death rate for adult-onset asthma is far higher than the death rate for childhood asthma.

The statistics are unnerving, but there are things you can do to reduce your risk of complications. (More on them in a bit, too.)

Triggers and lifestyle factors

Factors that increase your risk of developing adult-onset asthma include:

Family history: If other members of your biological family have asthma, there’s a better chance you’ll develop it, too.
Smoking: Inhaling chemical irritants increases your asthma risk, period — no matter what or how you smoke. The same is true of being around secondhand smoke.
Having overweight or obesity: A low level of physical activity, changes in lung physiology and higher levels of inflammation are among several factors that increase asthma risk.
Being female: Hormonal changes in pregnancy and menopause can trigger asthma in women.
Having allergies: Allergies happen when your immune system overreacts to irritants like dander, dust, mold and pollen. That same process can affect your breathing. In fact, adult-onset allergies can cause adult-onset asthma.
Your job: Being exposed to certain substances at work can damage or sensitize your lungs, making asthma more likely.
Other medical conditions: Severe respiratory infections, substance use disorder and certain medications are just a few of the additional factors that can raise your asthma risk.

Common challenges in the diagnosis and treatment of adults

Diagnosing and treating childhood asthma tends to be more straightforward than it is in adults.

Why is diagnosing adult-onset asthma more complex? We’ve mentioned the tendency to ignore symptoms until they’re really bad — but that’s not the only issue.

Even if you alert a healthcare provider as soon as you notice something’s off, the list of possible causes is much longer when you’re older. It also includes serious conditions that tend to emerge later in life, like:

Hiatal hernias
Esophageal disorders
Heart failure
Rheumatoid arthritis
Chronic obstructive pulmonary disease (COPD)
Several kinds of cancer

It’s important to rule out these possibilities, especially because some of these conditions are more common in people with asthma.

Diagnosing asthma will involve a breathing test. If you’ve been prescribed any maintenance inhalers, it’s important to hold off using these the day before and on the day of testing.

Once you and your provider know you have asthma, you’ll face another challenge: Finding the best way to manage your symptoms. Again, treating asthma is harder in adults than it is in children because:

Your lungs and chest walls are stiffer, and the muscles that support deep breathing can be weaker.
Asthma medications can be less effective later in life, particularly if you have overweight or obesity.
Oral steroids for asthma can worsen conditions like glaucoma, cataracts and osteoporosis.
Being on beta-blockers for heart problems can increase the severity of your asthma.

Inhaled and oral asthma medications, which open your airways and soothe inflammation, are often used to treat acute symptoms and prevent flare-ups. You may also need to take maintenance medications you take routinely, like biologics or inhaled corticosteroids.

Managing asthma as an adult

If you’re living with asthma, it’s important to follow your provider’s instructions as closely as possible and know your asthma triggers — that way, you can adjust your lifestyle to more easily avoid them. Here are a few examples from Dr. Taliercio:

Take prescription medications as directed. Talk to your asthma specialist about all the medications you take, including vitamins, supplements and over-the-counter remedies. They’ll make sure you’re on the safest regimen. And always consult your provider before making any changes.
Monitor your lung capacity. Visit your doctor frequently to have your lung function checked. You can also do it yourself at home using a peak flow meter. This can help you detect lung changes before your symptoms get worse.
Develop a step-by-step plan. Create an asthma action plan with your provider. These documents walk you and your caregivers through what to do if you’re having an asthma attack.
Use your rescue inhaler correctly. This may be tough if you struggle with strength or dexterity due to other health problems. If using your inhaler is too frustrating, ask your doctor about nebulized medications, which you can breathe in over 10 to 15 minutes.
Be proactive when you’re sick. If you’ve got a cold, the flu, COVID-19 or an upper respiratory tract infection, see your provider sooner rather than later. Your lungs may need extra help to make a full recovery.
Address air pollution. If you can, stay inside on days when the air quality is low. Also, take steps to reduce indoor air pollution, like investing in an air purifier.
Take your allergies seriously. Work with your provider to identify your allergy triggers and create a care plan to better manage your symptoms. Fewer allergy attacks may mean fewer asthma attacks.
Stop smoking. “Tobacco smoke is not only harmful to your throat and lungs, but it can also make your asthma harder to manage,” Dr. Taliercio explains. “Vaping is just as dangerous. Talk to your provider about how we can help you quit smoking.”
Exercise often. Staying active is one of the most important ways to stay healthy and manage your asthma. But it can also be a trigger. If you have exercise-induced asthma, start slow with a warm-up, have your medications handy and (if possible) work out indoors.

The mental and emotional toll

Like many chronic illnesses, adult-onset asthma can disrupt your life and hurt your mental health. But the reverse is also true: Taking care of your mental health may lessen your symptoms — and might even reduce the number of asthma attacks you have. Consider creating a mindfulness routine, practicing self-care, joining a support group and more.

“Breathlessness is stressful, but being stressed can make breathing even harder,” recognizes Dr. Taliercio. “Learning positive coping mechanisms can help you avoid that vicious cycle.”