Breathe In, Breathe Out: What to Know About Adult-Onset Asthma
We take our ability to breathe for granted. We all know humans need to inhale oxygen to live, but it's a rude awakening when we find ourselves unable to. At least, that was my experience when I had my first asthma attack.
At 38 years old, kneeling in my courtyard gasping for air, this was an extremely frightening experience and the event that expedited my diagnosis of adult-onset asthma.
What exactly is adult-onset asthma?
The best thing that happened for me was being seen by a pulmonologist: Fabio Giron, M.D.
"Adult-onset asthma is just that: Someone who did not have asthma as a child and first develops it as an adult," Giron said. "The main difference between adult-onset and child-onset is that children have a much higher chance of going into remission, often in their teenage years. In adults, it may be intermittent but it rarely goes away. It is more common in boys as childhood asthma and women as adult-onset. There is also a higher incidence of allergic asthma versus nonallergic in children compared to adults."
Asthma in adults is often triggered by allergies, exposure to allergens and irritants such as cigarette smoke, chemicals, molds, dust or other substances commonly found in a person's environment.
Symptoms of adult-onset asthma
Asthma in adults commonly looks like that in children, with symptoms including a cough, wheezing, chest tightness and shortness of breath.
"The standard test for asthma is the pulmonary function test, which can show airflow obstruction that can be corrected with treatment," Giron said. "The test is not perfect, and sometimes other testing needs to be done to confirm the diagnosis. Other conditions, such as COPD [chronic obstructive pulmonary disease], can cause airflow obstruction, so the clinical history is also important in establishing the diagnosis. In other words, the pulmonary function test alone is rarely solely relied on for the diagnosis."
Especially in older adults, asthma can mimic other illnesses, including hiatal hernia, stomach problems, heart failure and rheumatoid arthritis. There is also data that indicates women are more likely to develop asthma after the age of 20. Obesity can sometimes significantly increase a person's risk of developing asthma as an adult.
Treatment options for asthmatic episodes
The good news is that doctors have asthma treatment well in hand.
"The treatment depends on the severity, but since asthma is basically inflammation of the airways, anti-inflammatory therapy is the main treatment, usually in the form of inhaled corticosteroids. This is basically a topical form of therapy, so that side effects are minimal," Giron said. "Bronchodilators like albuterol are also used for rapid symptom relief."
Shawn Reid, a respiratory therapist in New York City, also outlined other rapid symptom relief options.
"During an asthma episode, the first line of defense are bronchodilators, like albuterol, or those combined with steroids, like beclomethasone, fluticasone, budesonide and/or anti-inflammatory xylometazoline," Reid said.
The efficacy of these treatments relies on a patient being able to recognize their symptoms, so learning signs and risk factors is critical. Reid also suggests that when experiencing an asthmatic episode, a patient should "remove any and all known triggers—don't delay treatment and follow your asthma action plan."
Combination treatments are options for patients on a maintenance program.
Misconceptions about adult-onset asthma
My road toward an asthma diagnosis was riddled with bumps. I initially had a really bad cough that prevented me from sleeping, for which my primary care physician prescribed strong cough syrup and antibiotics. I spent my 38th birthday recovering from what I thought was a bad chest infection, and a four-day hospitalization about six months later resulted in a diagnosis of bronchitis.
According to Giron, my situation isn't entirely uncommon.
"I will often hear an asthma patient tell me about an episode of 'bronchitis' that they had treated with antibiotics," he said. "Asthma is a common form of bronchitis (inflammation of the airways), so this is most often an asthma exacerbation. The other is regarding the concern of being on steroids to treat asthma and the potential side effects. Since they are low doses delivered straight to the airways, we do not see the type of side effects we see with systemic steroid pills."
Does an asthma diagnosis as an adult change your life?
My diagnosis greatly affected my overarching view of my health and made me more conscientious about my diet and lifestyle. Of course, this epiphany was even more heightened as it resulted in me being hospitalized for the first time, and was exacerbated by the COVID-19 pandemic.
In 90 percent of asthmatics, it can be well managed with medications and most, except the severe, will have a normal life expectancy.
Despite my worries, Giron said most cases of adult asthma are totally manageable.
"Asthma can certainly affect a person's quality of life depending on the severity, but in 90 percent of asthmatics, it can be well managed with medications and most, except the severe, will have a normal life expectancy. Death from asthma is rare and mostly preventable," Giron said. "We are also benefiting from newer treatment options for the more difficult cases that are being developed fairly rapidly."
Fortunately, my asthma is well-managed and I have not had an asthmatic episode in more than six months. Other than having to change my bronchodilator brands, I have experienced no issues and work out five days each week without incident.
My biggest takeaway from this experience is the importance of seeking professional medical care and following their advice when you receive it. If you find yourself having trouble breathing or experience any other symptoms of adult-onset asthma, don't hesitate—consult with a medical professional as soon as you can.