Feeling Wheezy?

Adult-onset asthma, which can mimic other conditions, often goes undiagnosed. Fortunately, treatment can help.

If you’ve been coughing more than usual lately, you may blame it on allergy season. And that shortness of breath you feel after you hurry up the stairs? Well, you’re older now, and perhaps you haven’t been hitting the gym enough.

Another possibility, though, is adult-onset asthma.

“It is very underdiagnosed in adults,” says Harshna Mehta, M.D., an allergist and immunologist with ENT & Allergy Associates, which has offices in Hackensack and Paramus. “Many people normalize symptoms like chronic cough or reduced exercise tolerance, attributing them to aging or being out of shape. Other symptoms such as chest tightness may be mistaken for cardiac disease.”

Asthma causes airways to narrow and sometimes produce extra mucus, making breathing difficult. And while it’s often thought of as a condition that affects children, some 40 to 50 percent of asthma cases are actually diagnosed in adulthood, says Dr. Mehta. “In fact,” she says, “close to half of adults with asthma report that their symptoms began after age 18. In clinical practice, we frequently see new diagnoses in patients in their 30s, 40s and beyond.”

And not getting that diagnosis can cause problems. Though asthma is manageable with the right medications and action plans, it’s also chronic— and it’s likely to get worse if it isn’t treated. “Early diagnosis and appropriate treatment can both significantly improve quality of life and prevent long-term complications,” says Dr. Mehta.

Three kinds of causes

No single reason explains why people develop asthma as adults. Doctors cite three categories of causes, and two of them are allergic and non-allergic. While those terms seem to cover everyone, they also mention a third group they label “occupational.”

• Allergic asthma, as the name suggests, is caused by an allergic reaction—that is, an abnormal immune response to something that is typically not harmful, such as foods, pollens or medicines. According to the American College of Allergy, Asthma and Immunology (ACAAI), sometimes asthma develops in adulthood simply because one has avoided an allergy trigger until then—for instance, one may start living in close proximity to a new type of animal or move to a place with a different type of pollen. Another possible reason is that immune responses, and therefore allergic reactions, can change with age, and one may gain a new sensitivity. Dr. Mehta flags “dust mites, pet dander, pollen and mold” as common allergens that trigger asthma.

• Non-allergic asthma can be produced by “respiratory infections, hormonal changes—particularly in women—obesity, chronic sinus disease and gastroesophageal reflux disease or GERD,” says Dr. Mehta. “GERD can contribute to airway inflammation and therefore asthma symptoms.” According to the ACAAI, a respiratory infection, particularly the flu or respiratory syncytial virus (RSV), which triggers a cough that lingers for weeks can be an example of non-allergic asthma.

• Occupational asthma develops when one is regularly exposed—on the job, for example—to “air pollution and irritants, such as smoke, cleaning agents or industrial chemicals,” according to the doctor. Those at risk range from hairdressers to bakers to farmers to laboratory and chemical-plant workers. Spending time around wet paint with high volatile organic compounds (VOCs) can also cause problems, as can long-term exposure to secondhand smoke from cigarettes or vapes. (Of course, smoking itself increases one’s risk of adult-onset asthma significantly.)

There’s also what Dr. Mehta identifies as “exercise-induced bronchoconstriction” or EIB, previously known as exercise-induced asthma. It’s no longer considered asthma because not everyone who experiences it has the chronic condition, but as many as 90 percent of people with asthma also have EIB, according to the ACAAI. It’s often triggered by quickly breathing air that is drier and/or colder than what is already in one’s body, and it causes chest tightness, wheezing and coughing. Symptoms typically appear during exercise and continue for 10 to 15 minutes after a workout. If it’s experienced in addition to a persistent cough when not exercising, it could be an indicator of asthma; if it is disrupting one’s routine as an athlete or otherwise, it can be treated in a way similar to the way asthma is treated.

When to worry

Says Dr. Mehta: “Though the core symptoms of asthma—wheezing, coughing, shortness of breath and chest tightness—are similar in both adults and children, they are often more subtle in adults. They are more likely to be persistent rather than episodic.”

In other words, children are more likely to have a sudden, dramatic asthma attack, like the ones you see on TV and in movies, while adults are more apt to have a stubborn symptom that lasts for weeks or months. “Chronic cough,” says the doctor, “may be the predominant symptom.”

Dr. Mehta adds that patients should seek medical evaluation if they experience nighttime coughing or chest tightness that awakens them, symptoms occurring more than twice per week, exercise limitation due to breathing difficulties or any sudden or severe shortness of breath. “These are signs that asthma may be uncontrolled and may require medical attention,” she says.

And make no mistake—adult-onset asthma does need to be checked out. When left untreated, it can damage and scar lungs and airways (a process called “airway remodeling”) and increase one’s risk of infections such as pneumonia. Also, an untreated, acute asthma attack can be fatal. According to the Asthma and Allergy Foundation of America, adults are seven times more likely to die from asthma than children, and nearly all asthma deaths are preventable with proper medical intervention.

What to do

The good news: “Treatment is highly effective and continues to evolve,” says the doctor. She says gold-standard treatment for short-term relief includes rescue inhalers, which administer a bronchodilator to relax the muscles of the airway and ease breathing, and inhaled corticosteroids to reduce inflammation in the long term. For more severe cases, an inhaler may include both.

“Newer developments include biologic therapies for severe asthma, which target specific inflammatory immune-system pathways and can significantly reduce both exacerbations and the need for oral steroids,” says Dr. Mehta. These biologic medicines are administered every few weeks or months. “There is also a growing emphasis on personalized treatment based on specific asthma types, as well as on ‘smart’ inhalers and digital tools that help improve adherence and outcomes.” Such devices have sensors that attach to inhalers and connect via Bluetooth to one’s smartphone; they can track information about when one last took a dose of medication, when the next one is due, and if the inhaler was shaken properly.

So if you find yourself wheezing more than usual, consider checking in with your doctor. If it turns out to be adult-onset asthma, know that effective treatment is available.