Got asthma as an adult? What to know about symptoms and how to control them
Asthma | 2/17/2023
Asthma research over the years has typically focused on children while asthma diagnosed in adults, known as adult-onset asthma, has received a lot less attention. Ten years ago, Professor Hannu Kankaanranta, then a clinician at Seinäjoki Central Hospital in Finland and now Asthma and Allergy Research professor at the Krefting Research Centre in Gothenburg, Sweden, set out to address this gap.
Why it is important to understand adult-onset asthma
“At that time there was much less data around on the asthma that starts in adulthood,” Kankaanranta recalls, “and a mismatch between the prevailing asthma guidelines and the kinds of patients visiting my clinic.”
While most of the medical material featured children with allergies or teens playing sports, more and more of his patients were adult-onset asthmatics, tending towards obese, some of them smokers and many already suffering from other diseases such as hypertension, Type 2 diabetes, even depression. And while the child asthmatics were leading quite active lifestyles, the majority of Kankaanranta’s adult patients had sedentary ones.
“We have always thought of asthma as a disease that starts in childhood, but for example studies from Finland show that actually three out of four diagnoses are adults – and we see similar data coming out of the US,” Kankaanranta says.
Kankaanranta’s research also showed that while symptoms like breathlessness in child asthmatics generally responded well to the typical corticosteroid treatment in inhalers, there were no such certainties with adult-onset patients. For example, in one long-term study of adult-onset, he found only 34% of patients using their normal inhaled treatment achieved full control, 36% partial control, and a remaining 30% not controlled at all. “It all started to click in my head,” Kankaanranta says. “Adult-onset asthma didn’t respond nearly as well to treatment. It was almost as if it were a different disease.”
Medication supports lung health
This is not to say that adult patients should stop their medication. On the contrary, Kankaanranta stresses the importance of sticking with your daily prescribed asthma control medication. A study by the group of Kankaanranta in 2021 shows a clear correlation between using asthma medication and good lung function.
“Even if it doesn’t always alleviate symptoms as much as you would like, using regular medication helps keep your lung function stable,” Kankaanranta affirms.
Many children outgrow their asthma in adulthood and no longer have symptoms or a need for medication. But in adult-onset asthma, this kind of disappearance of the disease is much less common. Kankaanranta confirmed this in a study, where only 3% of patients experienced the disappearance of symptoms.
Adult-onset asthma is more common in women
According to Kankaanranta, several factors may make a person more likely to develop asthma as an adult. While in childhood asthma, boys aged 0 and 9 have the highest probability of diagnosis, in adult-onset asthma it is women over 30 with the most cases. People who had asthma as children may also develop symptoms again in later life. He also highlights that obesity, smoking and inactive lifestyle are significant factors for worse outcomes in adult-onset asthma.
“While this is troubling on the one hand,” says Kankaanranta, “the good news is that these are things we can tackle as individuals.”
Why healthy lifestyles matter
There are many things we can do to get moving, whatever our age, Kankaanranta believes. It might be leaving the car at home and walking to the store, or taking up yoga or cycling to work. Getting out into the garden. Kankaanranta likes forest work like chopping wood for the winter fire. He is not fond of apps but if people find better motivation to exercise thanks to their phones or fitness trackers, it might be worth using them.
“I tell my patients, it’s not a question of what you do but if you do it,” Kankaanranta affirms. “And the good news is that I’m not telling them to go run a marathon, just to make lifestyle changes that help them feel healthier, and hopefully happier.”
By Laurel Colless
Photo by Adobe Stock
References:
Tuomisto LE, Ilmarinen P, Niemelä O, Haanpää J, Kankaanranta T, Kankaanranta H. A 12-year prognosis of adult-onset asthma: Seinäjoki Adult Asthma Study. Respir Med. 2016 Aug;117:223-9. doi: 10.1016/j.rmed.2016.06.017. Epub 2016 Jun 23. PMID: 27492535. https://pubmed.ncbi.nlm.nih.gov/27492535/
Kankaanranta H, Tuomisto LE, Ilmarinen P. Age-specific incidence of new asthma diagnoses in Finland. J Allergy Clin Immunol Pract. 2017 Jan-Feb;5(1):189-191.e3. doi: 10.1016/j.jaip.2016.08.015. Epub 2016 Oct 17. PMID: 27765463. https://pubmed.ncbi.nlm.nih.gov/27765463/
Hisinger-Mölkänen H, Honkamäki J, Kankaanranta H, Tuomisto L, Backman H, Andersen H, Lindqvist A, Lehtimäki L, Sovijärvi A, Rönmark E, Pallasaho P, Ilmarinen P, Piirilä P. Age at asthma diagnosis is related to prevalence and characteristics of asthma symptoms. World Allergy Organ J. 2022 Sep 16;15(9):100675. doi: 10.1016/j.waojou.2022.100675. PMID: 36185544; PMCID: PMC9489807. https://pubmed.ncbi.nlm.nih.gov/36185544/
Vähätalo I, Kankaanranta H, Tuomisto LE, Niemelä O, Lehtimäki L, Ilmarinen P. Long-term adherence to inhaled corticosteroids and asthma control in adult-onset asthma. ERJ Open Res. 2021 Feb 8;7(1):00715-2020. doi: 10.1183/23120541.00715-2020. PMID: 33585657; PMCID: PMC7869602. https://openres.ersjournals.com/content/7/1/00715-2020
Honkamäki J, Piirilä P, Hisinger-Mölkänen H, Tuomisto LE, Andersén H, Huhtala H, Sovijärvi A, Lindqvist A, Backman H, Lundbäck B, Rönmark E, Lehtimäki L, Pallasaho P, Ilmarinen P, Kankaanranta H. Asthma Remission by Age at Diagnosis and Gender in a Population-Based Study. J Allergy Clin Immunol Pract. 2021 May;9(5):1950-1959.e4. doi: 10.1016/j.jaip.2020.12.015. Epub 2020 Dec 15. PMID: 33338683. https://pubmed.ncbi.nlm.nih.gov/33338683/
Honkamäki J, Hisinger-Mölkänen H, Ilmarinen P, Piirilä P, Tuomisto LE, Andersén H, Huhtala H, Sovijärvi A, Backman H, Lundbäck B, Rönmark E, Lehtimäki L, Kankaanranta H. Age- and gender-specific incidence of new asthma diagnosis from childhood to late adulthood. Respir Med. 2019 Jul-Aug;154:56-62. doi: 10.1016/j.rmed.2019.06.003. Epub 2019 Jun 8. PMID: 31212122. https://pubmed.ncbi.nlm.nih.gov/31212122/
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