Who Gets Asthma?

Reviewed by: HU Medical Review Board | Last reviewed: December 2022

Anyone can develop asthma at any age. It is most common for people to start showing symptoms during childhood. But people can also be diagnosed with asthma for the first time as adults.1

Symptoms, diagnosis, and treatment are similar no matter when symptoms first start. However, asthma symptoms tend to be more severe when they start during adulthood. So adults with asthma may need higher doses or different medicines.1

Talk to your doctor about creating an asthma action plan. This can help you control your asthma symptoms by:2

  • Avoiding known triggers
  • Figuring out whether treatments are working
  • Knowing what to do in certain situations
  • Addressing flares early

Controlling symptoms reduces the risk of someone having an asthma attack and other complications.2

When do asthma symptoms usually start?

People often think that asthma is a childhood condition. Many people do first show symptoms during childhood. This is called childhood or pediatric asthma.3

However, you can develop asthma at any age. Many people develop asthma during adulthood. This type of asthma is called adult-onset asthma. It is also possible for asthma symptoms to disappear after puberty and then reappear during adulthood.4

The risk of developing asthma as a child or adult differs by sex. As children, boys have a higher risk of developing asthma than girls. As adults, women have a higher risk of developing asthma than men.1,4,5

How are symptoms of childhood and adult-onset asthma different?

Symptoms of asthma are similar whether they start during childhood or adulthood. Common symptoms include:1,6

  • Shortness of breath
  • Coughing and wheezing
  • Chest tightness

However, symptoms of adult-onset asthma tend to be more severe and frequent. Symptoms of childhood asthma are often intermittent, meaning they come and go. They may only be triggered by allergies or infections. Adults with newly diagnosed asthma often have more persistent symptoms.1,7

About half of children with asthma report having had an asthma attack in the past year. Adult-onset asthma may be linked to more frequent asthma attacks. Controlling symptoms can help lower the risk of asthma attacks and other complications, including:6,8

  • Permanent decline in lung function
  • Hospitalization
  • Worse academic or job performance
  • Interference with sports and social activities

What causes childhood or adult-onset asthma?

In childhood and adult-onset asthma, the lungs and airways become easily inflamed. This can lead to narrow or blocked airways. Airways also becomes more sensitive to exposure to certain triggers. When this happens, it becomes harder to breathe air in and out of the lungs.1,6

Risk factors

We do not know what exactly causes airway inflammation in asthma. But childhood asthma and adult-onset asthma seem to have different risk factors.1,4,6

Childhood asthma seems to be more often linked to:6

  • Other allergic conditions
  • Family history of asthma
  • Viral infections during infancy
  • Exposure to certain other environmental factors before and after birth

Adult-onset asthma is more often linked to:1,4

  • Work-related exposure to chemicals or allergens
  • History of smoking
  • Respiratory infections and nasal congestion
  • Hormonal fluctuations (in women)
  • Stressful life events
  • Higher body weight

Triggers

We know more about common triggers of asthma symptoms. Many of these are similar for childhood and adult-onset asthma. They include:1,6

  • Viral infections, such as the common cold
  • Air pollution
  • Allergens, such as dust mites, pet dander, pollen, insects, rodents, and mold
  • Physical activity
  • Weather changes
  • Certain medicines

Different types of asthma are defined based on these triggers. Some types of asthma are more common in adults. This includes aspirin-induced asthma.1,6

How are childhood and adult-onset asthma diagnosed?

Childhood and adult-onset asthma are diagnosed based on the same information:7,9

  • Symptoms
  • Physical examination
  • Lung function tests

A family history of asthma or allergic disease may be helpful to diagnose childhood asthma. In adult-onset asthma, diagnosis may be complex due to other conditions with similar symptoms. For example, emphysema and chronic obstructive pulmonary disease (COPD) are more common in adults.7,9

In either type of asthma, a lung function test called spirometry is key to diagnosis. Spirometry can determine how well and how much air you can breathe. Sometimes people with normal spirometry still have asthma. This test may be difficult for certain people, such as younger children and older adults.7,9

How are childhood and adult-onset asthma treated?

Childhood and adult-onset asthma are managed with similar treatments. An asthma action plan will help you monitor and manage symptoms. Effective management can allow you to participate in your usual activities. The main steps to managing asthma include:7,9

  • Avoiding known asthma triggers
  • Maintaining a healthy body weight
  • Controlling other chronic (long-term) conditions
  • Long-term asthma drugs (such as inhaled corticosteroids) to control daily symptoms
  • Quick-relief drugs (such as short-acting beta-agonists) for relief during an asthma attack

Adults are more likely to take medicines that interfere with asthma drugs. So people with adult-onset asthma may need higher doses or different medicines.1,5

In any type of asthma, your doctor will follow a stepwise treatment approach. This means they will increase or decrease your treatment depending on symptoms. This approach helps you control symptoms using the least medicine needed. This reduces the risk of side effects.2,10

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