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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, Obesity Associated, 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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Hesselmar, et al, “The Heterogeneity of Asthma Phenotypes in Children and Young Adults,” Journal of Allergy (Cairo), 2012,, accessed 8/4/17
  2. Wu, Tsung-Ju, “Age of asthma onset and vulnerability to ambient air pollution: an observational population-based study of adults from Southern Taiwan,” BMC Pulmonary Medicine, 2016,, accessed 8/4/17
  3. Selma B., et al, “Adult-Onset Asthma: Is it really different?”  European Respiratory Review, 2013,, accessed 8/4/17
  4. Wenzel, Sally, “Severe Asthma: Can phenotyping help with understanding and treatment,” UPMC Physician Resources,, accessed 9/20/17


  • marti
    2 years ago

    I am an early onset. At age 2 yrs. since the 50s. Medicines have come a long way. Before the 50s there was really nothing that one could use at home for relief. Had many hospital trips. I had real hard times coping at my school years. I have severe allergies, sinus, and bronchitis asthma. Have had to take many steroid treatments and several controlling meds. Now more people are starting to understand the disease. Thanks for the information that asthma net provides. Hope more and more people will become aware of its severity and better understanding of life one deals with.

  • John Bottrell, RRT moderator author
    2 years ago

    You are welcome. Having been diagnosed 20 years after you early in my life, I actually had to go the first ten years of my life without inhalers. After I was introduced to them, I often wondered what life would be like for me if I was born 20 years earlier. It is so neat how far asthma research has advanced since we were born. The hope is, now that asthma awareness is increasing, that the next 10 years will offer a thousand year leap as far as asthma wisdom is concerned. Thanks for sharing. John.

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