Can Adults Develop Asthma?

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

Asthma is a chronic lung disease whose inflammation and narrowing of airways impedes breathing. 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?”

While childhood asthma is often associated with genetic and allergic mechanisms, true adult-onset asthma is usually associated more with environmental and lifestyle factors, says Santhi Kumar, MD, a pulmonary and critical care medicine specialist with Keck Medicine of USC. (Dr. Kumar does point out, however, that in some cases, adults may not have known they had asthma as a child because they didn’t have any symptoms then, or they may have unknowingly adapted to any reduced lung function. Then, when noticeable asthma symptoms do emerge in adulthood, they may seem like a brand-new development.)

In general, when it comes to adult-onset asthma, the timing of onset is often related to the cumulative interaction of exposures to irritants in the environment, genetic susceptibility and lifestyle factors, Dr. Kumar says. Key risk factors associated with adult-onset asthma include occupational exposures, obesity and weight gain, smoking and vaping, and air pollution.

For instance, Dr. Kumar says, it’s been cited that 5%-20% of new asthma cases in adults are attributed to occupational exposures. For this reason, part of evaluating patients with new asthma symptoms requires gathering information about their work history and possible exposures so that patients can avoid triggers. Wearing protective equipment in certain situations may also help mitigate symptoms.

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.

In addition to occupational and environmental exposures, weight gain and obesity have been associated with adult-onset asthma. Obesity increases the risk of developing asthma by 30%-50%, making weight management one of the most modifiable risk factors for preventing the likelihood of getting asthma as an adult. The relationship between weight and asthma particularly affects middle-aged adults and especially females, Dr. Kumar notes.

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.

Symptoms that don’t seem to get better after a few weeks may need to be evaluated with additional testing to see if there may be something else going on, Dr. Kumar says.

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. Adult asthma symptoms have also been found to be more severe and need more intensive treatments than childhood asthma, Dr. Kumar says. 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. “One of the tests we do to evaluate asthma is a pulmonary function test, where we see how air moves in and out of your lungs and whether we can see changes in airflow that could be explained by asthma,” Dr. Kumar 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. If you are prescribed medication to manage your asthma, take them as prescribed. This can be easier said than done. Using an inhaler correctly can be challenging, for instance, and not all inhalers work in the same way. Online resources are available to walk patients through proper inhaler techniques, and your medical team can also serve as a resource to help ensure you are using your inhaler correctly.

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.

“Asthma is very treatable,” Dr. Kumar says. “With the right plan, most people live full, active lives.”

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