January 8, 2018

Important facts about adult asthma


If you have allergies, GERD or are pregnant, you may have an unwelcome health guest: adult-onset asthma. Learn the facts.

Asthma has a lot of myths surrounding it. We often attribute the characteristic wheezing and shortness of breath to kids and think of asthma as something that will be “grown out of” like a pair of shoes. Unfortunately, many asthmatics will experience a worsening of symptoms as they age, and some people who didn’t have asthma as a child will be diagnosed with it in adulthood. We asked David Hagaman, M.D. at Vanderbilt’s Asthma, Sinus & Allergy Program, to answer some questions about adult asthma triggers and symptoms.

What are typical asthma symptoms in adults?

There are a variety of signs of developing asthma. Adult onset asthma will typically present as shortness of breath, wheezing, coughing or a chest tightness or pain. If you’re asthmatic, you will likely experience a bronchospasm during exercise, Hagaman said. That’s when the muscles in your bronchi walls constrict and cause your airways to narrow, making it difficult to breathe. If you’re experiencing these symptoms, talk to your doctor. You may have adult-onset asthma.

“Sometimes we’ll see folks who just really slow down and stop exercising and stop exerting themselves,” Hagaman said. “They don’t perceive that it’s because their lungs are responding in a negative way. They just know they don’t feel well, so they stop doing it.” Doctors often use an exercise challenge to diagnose asthma, especially in adults.

Which people at more at risk for adult-onset asthma?

The following people have greater chances of developing asthma as adults: 

You had asthma as a kid.

Exercise-induced asthma is the more common type of adult-onset asthma, but allergic asthma is more prevalent in children than adults, Hagaman said. “A lot of times it goes away during puberty and the teenage years, but then comes back later in the late 20s and 30s,” he said. In allergic asthma, exposure to allergens triggers the bronchospasm that leads to breathing difficulty.

You have allergies or sinus issues.

Even if you’ve never had asthma, chronic allergies and sinus issues can trigger lung irritation that can lead to asthma. “We call it ‘one airway, one disease,’” Hagaman says, “meaning from the tip of your nose to the bottom of your lungs, the histology of the mucous is all very similar. We make a big point of controlling nasal inflammation so that there is less triggering of the lower airway.” If you’re plagued with allergies or nasal congestion, talk to your doctor about the best treatment for your symptoms.

You’re pregnant or going through menopause.

Although researchers are still determining the specifics, studies show that female sex hormones could play a role in adult asthma. “Oftentimes it will get worse or it will rear its head during pregnancy,” Hagaman said. “And a lot of times it will continue then.”

You have GERD.

If you have acid reflux, you’re also at risk for developing asthma or experiencing worsening symptoms. With reflux-related asthma, acid enters the esophagus and triggers the nerves there to cause a bronchospasm. “We call the reflux that will trigger asthma ‘silent reflux,’ meaning the patient doesn’t feel classic heartburn,” Hagaman says. “They just cough and wheeze.”

If you already have asthma, you may be more prone to GERD (gastroesophageal reflux disease), research shows. When asthma symptoms flare, the lower esophageal sphincter sometimes relaxes, letting acid or stomach juices into the esophagus. Unfortunately, some medications used to control asthma make reflux worse. “It can be a vicious cycle,” Hagaman said.

You work around dust or fumes.

Your job could also put you at risk for adult-onset asthma. Those who inhale dust or chemical fumes are most susceptible. Pastry chefs, hairstylists, mechanics and famers are just a few examples. According to the U.S. Centers for Disease Control and Prevention, approximately 17 percent of adult-onset asthma cases can be attributed to work-related exposures. “We see a lot of occupational asthma,” Hagaman said.

If you’re concerned about what you’re breathing in at work, talk to your doctor about how to best protect your lungs.

Learn more

Contact Vanderbilt Asthma, Sinus and Allergy Program for an evaluation and the most up-to-date treatment recommendations. Call 615-936-2727 for an appointment.