Can Adults Develop Asthma?

A Keck Medicine of USC pulmonologist explains why adults may start experiencing asthma symptoms.

If you weren’t diagnosed with asthma as a child but have started experiencing asthma-like symptoms as an adult, you may be wondering: “Can adults develop asthma?”

Richard Barbers, MD, a pulmonologist and allergist with Keck Medicine of USC, says that true “adult onset” asthma is infrequent. Asthma is a chronic lung disease whose inflammation and narrowing of airways impedes breathing.

Asthma in adulthood is often preexisting. Dr. Barbers says population studies show that half of children who had asthma by age seven will still have asthma when they reach age 50.

Sometimes adults may not have known they had asthma as a child because they didn’t have any symptoms, or they may have unknowingly adapted to any reduced lung function. When noticeable asthma symptoms do emerge in adulthood, they may seem like a brand-new development.

Dr. Barbers also points out that oftentimes adults develop asthma-like symptoms — coughing, wheezing, shortness of breath — that are an overreaction to environmental irritants. This reaction is classified as reactive airway disease (RAD). It occurs when specific triggers in the environment at home, outdoors or at work irritate the bronchial tubes.

Is it asthma…or not?

Those who have reactive airway disease develop symptoms in a predictable pattern, Dr. Barbers says. Some common triggers that usually affect even healthy individuals may be from cleaning solutions or toxic fumes. However, a patient with asthma may be even more susceptible to these irritants. Identifying a link between exposure and symptoms is important so that you can start avoiding an irritant.

For instance, Dr. Barbers says, “Patients whose symptoms worsen at work and improve on weekends have classic signs of job-related exposure.” You may need to limit workplace exposures to irritants, wear protective equipment, make job modifications or change jobs. Dr. Barbers also notes that RAD symptoms occurring at the workplace (also called occupational asthma) may continue even years after leaving a job, as was noted in workers exposed to Western red cedar dust.

Environmental irritants can also be acute, such as a single massive exposure to chemicals or smoke, or they can be chronic, stemming from years of exposure to certain cleaning products. City living also can also increase risk due to poor air quality.

What are the symptoms of asthma?

For those who do have asthma, symptoms often overlap with those of other conditions, making diagnosis tricky. The most common signs of asthma include:

• Persistent cough (especially at night or early morning)
• Wheezing or a whistling sound when breathing
• Shortness of breath
• Chest tightness or pressure
• Coughing up mucus or phlegm

While such symptoms in people with a common respiratory infection tend to resolve in a week or two, if your symptoms last more than a couple weeks, interfere with daily life or worsen over time, you should see a doctor to determine if you could have asthma.

“If a patient says, ‘I haven’t been able to shake this off,’ it may be time to dig deeper,” Dr. Barbers advises.

How is asthma diagnosed?

Primary care providers can manage many asthma cases, but severe or persistent cases may require specialist care from a pulmonologist or an allergist. Getting the right diagnosis early can prevent years of improper treatment.

To diagnose asthma, physicians collectively evaluate your history, physical exam and lung function tests. “The first thing I would probably do is spirometry — a simple pulmonary function test that can be done in a doctor’s office,” Dr. Barbers says.

When symptoms seem tied to specific triggers, a doctor may perform allergy testing. Your doctor may also prescribe use of a trial inhaler to see how you respond.

How is asthma treated?

Asthma treatment combines managing triggers and proper medication use. While identifying triggers can be challenging, “you need to be a persistent detective,” Dr. Barbers says, so that you can reduce your exposure as soon as possible.

If you are prescribed medication to manage your asthma, take them as prescribed, which can be easier said than done. “Even after initial training, about three-quarters of patients aren’t using their inhaler correctly by their next appointment,” Dr. Barbers notes. For severe asthma cases, treatment may combine use of inhalers and biologics (monoclonal antibodies).

Finally, certain lifestyle changes can help, such as reducing stress, getting enough sleep and maintaining a healthy weight.

With proper management, “there should be no reason why you should not be able to have a more healthy lifestyle like someone without asthma,” Dr. Barbers says.

Topics