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


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.

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