Asthma in Adults — It Doesn’t Always Start in Childhood

By Dr. Gabriel Grabowski, specialist in internal medicine and pulmonology

Many people associate asthma with childhood. However, it can first develop at 50, 60 or later, even in someone who has never previously had breathing problems. This is often called adult-onset asthma.

In my practice, I often discuss whether a persistent cough or breathlessness might reflect an airway condition rather than simply ageing or reduced fitness. These symptoms deserve assessment, but they do not automatically mean asthma. A careful medical history and appropriate tests help clarify the cause.

What adult-onset asthma can feel like

Asthma involves inflammation of the airways and a tendency for them to narrow in response to certain influences. Symptoms often vary over time: breathing may feel comfortable on one day and more difficult on another.

Typical symptoms include:

• Wheezing, particularly when breathing out
• Shortness of breath during activity or at rest
• A feeling of tightness in the chest
• Coughing, especially at night or early in the morning

Not everyone has all these symptoms. Sometimes coughing is the main complaint. Symptoms may become noticeable after a respiratory infection, although a cough after an infection does not necessarily indicate asthma.

For adults over 50, it is particularly important to consider other explanations. Chronic obstructive pulmonary disease (COPD), heart conditions, reflux and certain medicines can cause similar symptoms. More than one condition may also be present. I therefore avoid making a diagnosis from symptoms alone.

Triggers are individual, and allergy is not always involved

Adult-onset asthma is not always associated with an allergy. Some people react to pollen, house dust mites or animals, while others notice symptoms mainly with irritants, infections or changes in temperature.

Possible triggers include:

• Tobacco smoke, including second-hand smoke
• Dust, cleaning sprays and strong fumes
• Cold air or physical exertion
• Respiratory infections
• Substances encountered at work, such as flour dust or chemicals

Some medicines, including certain painkillers and beta-blockers, can worsen asthma symptoms in susceptible people. Do not stop prescribed treatment yourself; bring a complete medication list to your appointment, including eye drops and non-prescription products.

I also ask whether symptoms improve on weekends or holidays. This can provide clues about workplace exposure. Keeping brief notes about when symptoms occur may help, but deliberately exposing yourself to a suspected trigger is not advisable.

What a lung function test can tell us

An important part of assessment is spirometry, a lung function test. You breathe into a device that measures how much air you can breathe out and how quickly you can do so. The team explains the technique, and several attempts are usually needed to obtain reliable measurements.

The test may be repeated after an inhaled medicine that opens the airways. A significant improvement can support an asthma diagnosis when considered alongside the symptoms and medical history.

A normal result does not always exclude asthma, because airflow can be normal between episodes. Depending on the findings, I may recommend repeat testing, a home peak-flow diary or additional investigations. These may include measuring exhaled nitric oxide, which can provide information about a particular type of airway inflammation. No single test answers every question.

Inhalers: understanding their different roles

Inhalers deliver medicine directly to the airways. Broadly, inhaled medicines can reduce inflammation, relax the muscles around the airways, or combine both actions. For adults with asthma, treatment generally includes an inhaled corticosteroid to address inflammation rather than relying on a short-acting reliever alone.

The choice of device and treatment schedule depends on the diagnosis, symptom pattern, test results and individual circumstances. Some inhalers are used regularly; others may be prescribed for symptom relief, and certain combinations can serve both purposes under a specific plan.

In my consultations, I place particular emphasis on inhaler technique. Different devices require different breathing actions. Hand strength, coordination and the ability to inhale forcefully can affect which device is suitable. Ask for a demonstration and let the clinician check your technique. Discuss side effects and any difficulties before changing treatment.

When to arrange an assessment

Arrange a medical appointment for recurrent wheezing, unexplained breathlessness or a cough that persists, particularly if symptoms disturb sleep or limit usual activities. Sudden or severe breathing difficulty, or difficulty speaking because of breathlessness, requires urgent medical help.

If asthma is diagnosed, regular reviews and an individual written action plan can help you understand your medicines and what to do if symptoms change.

Consultations are possible at the three practices in Nürnberg, La Cala de Mijas and Estepona.

This article is general information and does not replace a personal medical consultation.