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Adult asthma

Image copyright Asthma UK

Asthma is a common long-term condition that can affect people of all ages. It causes inflammation in the airways.

The term adult asthma refers to either:

Adult asthma is often linked with allergies and accompanied by other allergic conditions, such as hayfever. Adult asthma is more common in females.

  • Symptoms

    Adult asthma causes on-going symptoms of wheezing, breathlessness, chest tightness and coughing. These symptoms can occur any time, but particularly at night or in the early morning.

    Adults with asthma can display a wide range of these symptoms, with different levels of severity. Sometimes symptoms can worsen over hours or minutes, leading to a severe restriction of the airways known as an asthma attack. This is usually only relieved by extra medication, or in severe cases, hospitalisation. Some very severe episodes can be life-threatening, although death from an asthma attack is uncommon.

    Worsening of symptoms is usually provoked by lung infections. These are especially common in winter and after the summer holiday period.

    In adults who have allergies alongside their asthma, symptoms are provoked by exposure to allergens, such as house dusts, pets of materials at work. Other common triggers include physical exertion in cold or dry air and traffic pollution.

  • Causes

    Most adult asthma begins in childhood. Two-thirds of children with asthma see the condition disappear in their teenage years. About a third of these cases reappear in adulthood.

    The risk of developing asthma is linked to genetic factors, i.e. the genes a person inherits from their parents, and environmental factors, such as exposure to allergens or pollutants. When these factors interact, for example a person who is genetically susceptible living in a highly polluted area, it increases the risk further.

    Researchers have identified a small number of genes that make people more susceptible to developing asthma. However, further research is needed to test different genes and their impact on the condition.

    One important type of asthma in adulthood is occupational asthma. This is caused by materials in the workplace. It is thought that 15% of all adult asthma is work-related. Find out more about work-related lung conditions.

  • Prevention

    In most cases of asthma, the origins of the condition are unknown and it is difficult to know the best way to prevent its development. The main exception to this is occupational asthma, which can be prevented if exposure to the material causing the asthma is carefully controlled, or a person is removed from the exposure.

    In general, prevention or control of asthma symptoms is possible with medication.

  • Treatment

    There is no widely used test that can diagnose asthma therefore it is identified and assessed by responses to questionnaires, simple tests looking at lung function and information on hospital attendances and drug prescriptions.

    The symptoms of asthma are also not specific to the condition. It is therefore likely to be confused with other conditions such as chronic obstructive pulmonary disease (COPD).

    There is no cure for most types of adult asthma, therefore the primary goal is to manage rather than cure the condition. This includes achieving and maintaining control of symptoms, and preventing any worsening of symptoms and asthma attacks.

    Healthcare professionals use the term ‘asthma control’ to refer to how well the symptoms are managed and the impact they have on daily activities. The term ‘asthma severity’ is used to describe the difficulty in controlling asthma with treatment and helps doctors decide what level of treatment is required.

    Management of the condition includes:

    •  Avoiding passive or active smoking
    •  Identifying any factors that trigger or worsen symptoms
    •  Avoiding exposure to airborne allergens
    •  Avoiding exposure to high levels of air pollution

    Asthma control remains relatively poor in Europe, despite the increasing use of asthma medications. Medications include:

    • Controller medication: This medication is taken regularly to build up a protective effect against asthma symptoms. This medication is usually in the form of inhaled corticosteroids (ICS), used with or without long-acting β-agonists
    • Reliever medication: These are taken to relieve asthma symptoms. They relax the muscles surrounding the narrowed airways and can be used in the event of an asthma attack or worsening of symptoms. These are usually in the form of short-acting β-agonists

    Each person is different and will not require the same level of treatment. The doses of medication are therefore modified according to a person’s individual symptoms. It is important that people learn which treatment works for them to help them manage their condition by themselves.

    About 10% of adults with asthma have persisting symptoms and exacerbations which they are unable to control, despite taking adequate treatment. This asthma is referred to as ‘difficult-to-treat’ asthma and can often have a damaging effect on a person’s quality of life.

    Although death from asthma is relatively uncommon, it can occur in any adult with poorly controlled asthma.

  • Burden

    • Asthma affects people of all ages in all countries. It is most common in childhood but can persist into adulthood
    • Asthma prevalence has increased in the second half of 20th century but has levelled off in the past decade
    • Around 10% of adults with asthma have severe asthma, which is difficult to treat
    • In Europe, almost 10 million children and adults less than 45 years of age have asthma
    • Death from asthma in adulthood is uncommon and in most European countries death rates are falling
    • In some countries, such as Finland and France, action by government health departments has led to important improvements in asthma control
    • The burden tends to be higher in Western and Northern countries in Europe, where prevalence may be higher than 10%
    • The UK and Ireland have some of the highest asthma rates in Europe and the world
    • Out of a survey of seven European countries, Sweden had the highest use of inhaled corticosteroids in both adults and children
    • The European Commission provide a public health summary of asthma, including links to statistical data 
    • The Lung and Asthma Information Agency provide a summary of the epidemiology of severe asthma (PDF) in Europe

    Prevalence of asthma ever in adults aged 18–44 years. Data from World Health Organization World Health Survey, 2002–2004. Sigurkarlsson et al., 2011; Polish Multicentre Study of Epidemiology of Allergic Diseases; European Federation of Allergy and Airways Diseases Patients Associations; and the Serbian Health Insurance Fund.

  • Current and Future Needs

    • There is a pressing need to understand the origins of asthma so that it can be prevented
    • Exposures in the workplace need to be better controlled to help prevent the development of adult asthma
    • More focused national programmes to improve asthma control across the population and consequently reduce long-term illness, death and costs
    • New therapies need to be developed to focus on treating asthma that cannot be controlled by current methods of medication. This will involve the investigation of the different types of asthma and how it manifests itself in individual people. This will lead to the development of personalised medicine that will match the appropriate treatments to the right individual

    Read more about the U-BIOPRED and AirPROM EU projects which are hoping to understand more about asthma to help develop personalised treatments in the future.