Asthma Subgroups: Early And Late Onset

It makes a difference when in the course of a person’s life a diagnosis of asthma is made. That said, here are some of the basic differences between early-onset asthma and late-onset asthma.

Early-onset asthma

Here are some facts.

• It's asthma diagnosed before the age of 12.
• It's generally well understood by the medical profession.
• It’s very likely to be associated with a family history of asthma and/or allergies.
• About 95% are diagnosed before the age of 6.
• This is because children are usually exposed to allergens at an early age.
• So, there is a high likelihood that it's associated with allergies (like, close to 100%).
• Meaning, a diagnosis of allergic asthma is common.
• This makes it less heterogeneous (variable) than late-onset asthma
• It's more likely to be diagnosed in males than females.
• 40% have a secondary diagnosis of eczema.
• It's often associated with a secondary diagnosis of allergic rhinitis.
• It may be caused by a mom smoking before the birth of her child.
• It may be caused by exposure to cigarette smoke early in life.
• There is a high likelihood asthma is triggered by respiratory viruses or colds.
• So, a diagnosis of virus-induced asthma is likely.
• Their asthma is associated with increased levels of eosinophils.
• Meaning the underlying airway inflammation is eosinophilic inflammation.
• Eosinophilic inflammation responds well to corticosteroids.
• So, eosinophil levels go down to normal levels (or close to it) between asthma episodes.
• Lung function is usually normal or close to normal between episodes
• Since it responds well to inhaled corticosteroids (ICS), a daily regimen of ICS can make episodes between attacks long, and attacks mild and easy to control when they do occur.
• Their asthma may also respond well to leukotriene antagonists like Singulair.
• It is most commonly mild or moderate, although sometimes severe.
• How it advances from mild to moderate to severe remains poorly understood.
• It may advance due to chronic exposure to environmental factors (like dust mites or viruses).
• Or, it may advance due to some sort of genetic reason (certain asthma genes).
• Still, for the most part, their asthma usually has a good prognosis, meaning that it is usually easily controlled by trigger avoidance and with a daily regimen of ICS, either alone or in tandem with one or two other medicines such as Singular or Xolair.

Late-onset asthma

Here are some facts.

• It is asthma diagnosed after the age of 12.
• It is generally not well understood by the medical profession.
• More specifically, it’s diagnosed after the beginning of puberty.
• It’s less likely to involve a family history of asthma than early-onset asthma.
• Only 4% have a secondary diagnosis of eczema, compared with 40% of early-onset.
• Making it more difficult to diagnose a specific asthma subgroup.
• While early onset is usually allergic, late-onset can be allergic, although it more than likely involves a diagnosis of any of the following asthma subgroups: infection-induced, premenopausal, late-onset eosinophilic, occupational, GERD, aspirin-sensitive, neutrophilic, COPD-asthma overlap syndrome.
• It is more likely to be severe compared with early-onset asthma.
• Therefore more likely to be compounded by a diagnosis of severe asthma.
• Hence, more rapid loss of lung function is possible compared to early-onset.
• Declines in lung function are more likely to be permanent, compared to early-onset.
• So, it also tends to be more difficult to obtain ideal asthma control than early-onset.
• As you can see, it tends to be more heterogeneous than early-onset asthma, meaning that how asthma presents tends to be unique from one asthmatic to the next.
• And this makes it difficult to diagnose.
• It is more likely to be diagnosed in females than males.
• In fact, females are almost more than 50% more likely to be diagnosed with it than men.
• It’s more likely to be caused by pollutants in the air than early-onset asthma.
• It might be caused by chemicals or irritants in cigarette smoke or wood smoke.
• It might be caused by chemicals or irritants in the air at your work
• It might be caused by air polluted by substances such as diesel fuel.
• Treatment usually begins with traditional asthma medicines.
• Although, it may entail the highest doses.
• It may also entail second-line asthma medicines.
• Or even medicines not normally prescribed for asthma, such as oral contraceptives, which might prove beneficial with premenopausal asthma

Conclusion

So, these are just some of the differences between early-onset and late-onset asthma. This is an important distinction to make because when asthma is diagnosed can make a difference in how it presents and how it's treated.