The Difference Between Adult Onset Asthma and Childhood Asthma

by Frederic Little, M.D. Health Professional

Asthma that comes when you're an adult

In response to reader inquiries, I would like to address the somewhat puzzling fact that some individuals develop asthma in adulthood. For many, this seems unusual as we all have acquaintances (family or other) that had asthma or allergies as a child and "grew out of it." Others have had asthma since they were children.

But the truth is, "adult-onset asthma" is not that uncommon - and it's not that different from childhood asthma when it comes to diagnosis and treatment.

Developing asthma as an adult

While they are in the minority, roughly 10% to 20% of adults with asthma developed their asthma as an adult. As this is less common, the diagnosis of adult-onset asthma can be more tricky to diagnose. Some adults will, instead, be given a diagnosis of chronic bronchitis. If they have smoked cigarettes in the past (or present), doctors might consider them to have chronic obstructive pulmonary disease (COPD), which is found almost exclusively in individuals with a heavy smoking history (smoking a pack a day for 20 or more years).

In order to accurately diagnose adult-onset asthma, you should talk to your physician about your symptoms (e.g. wheeze, cough, shortness of breath); what brings on your symptoms, and ask that he or she consider performing pulmonary function tests (PFTs). This test will help distinguish adult asthma symptoms from other causes of shortness of breath.

Adult asthma is a little different from childhood asthma

There are a few features that researchers have identified that are different in adult onset asthma compared to child-onset asthma:

  • Typically, adult-onset asthma patients are unlikely to "outgrow" their asthma and are somewhat more likely to require daily controller medications. A recent study showed that, in contrast to childhood asthma, only 5% of individuals with adult-onset asthma went into remission (when they no longer need treatment for their asthma).

  • Women are more likely than men to develop asthma after the age of 20. This may be related to female hormones, as it has also been observed that many women with asthma will have more symptoms at the beginning of menstruation.

  • While important, the role of allergies in adult-onset asthma is less significant than those with childhood-onset asthma (see earlier entry on association between asthma and allergies). It is more likely that adult-onset asthmatics will have so-called irritant triggers - such as exhaust, strong smells, and dust particles. Also, as there is a risk of asthma that is associated with exposures at work - occupational asthma.

It should be made clear that for asthmatics of all ages, viral upper respiratory infections (a cold,, for example) remain a very common trigger for asthma flares.

Adult-onset asthma treatment

Compared to the differences in causes and diagnosis of asthma in adults, asthma treatment for adult-onset asthma is very similar to treatment for individuals with childhood-onset asthma. The key elements are:

  • Asthma trigger identification and avoidance

  • Monitoring peak flow and asthma symptoms at home

  • Taking medications as prescribed, especially controller medications.

As usual, any asthma treatment plan will be individualized and the product of direct communication with your asthma provider.

There is one important note regarding asthma treatment in adults - whether adult or childhood onset. Unlike children and adolescents, adults are more likely to have other medical issues for which they are taking medication. Some of these conditions and treatments may be affected by asthma medications. It is critical that your asthma provider know all the medications you are taking when putting together an asthma treatment plan - both prescription and over-the-counter.

While there are subtle differences between adult and childhood-onset asthma in terms of diagnosis and prognosis, the goals of treatment for the doctor and patient remain the same - trigger avoidance, symptom control, and an individually tailored action plan and medication regimen.

Frederic Little, M.D.
Meet Our Writer
Frederic Little, M.D.

Frederic Little is an Assistant Professor in the Department of Medicine at Boston University. He attends on the Allergy Consultation Service as well as the Medical Intensive Care Unit and Pulmonary Consultation Service at Boston Medical Center. He wrote for HealthCentral as a health professional for Asthma and Allergy.