Surprising Signs of Adult-Onset Asthma

That persistent cough that keeps you up at night may stem from more than just a tickle in the back of your throat. It could be adult-onset asthma.

Many people experience a jolt of disbelief when they are diagnosed with asthma later in life, especially if they have never experienced symptoms before. Asthma? That condition that causes kids to wheeze?

It turns out adult-onset asthma is far more common than many people realize. “Asthma is often considered a disease of children, so adults may be surprised when they are diagnosed with asthma,” says pulmonologist Javier Pérez-Fernández, M.D., the critical care director at Baptist Hospital of Miami.

The number of people with asthma grows every year. Currently, more than 26 million Americans have asthma, according to the U.S. Centers for Disease Control and Prevention.  Of those cases, more than 20 million are among adults, with the greatest number of cases among ages 35 and 65.

Asthma is a chronic inflammation of the lung airways that can lead to coughing, chest tightness, shortness of breath or wheezing. Among adults who develop asthma later in life, the symptoms may initially be more subtle than in children, which can cause patients to overlook or ignore the condition. But it’s important to treat symptoms as soon as possible so they don’t become severe, said Dr. Pérez-Fernández, who also serves as director of pulmonology for West Kendall Baptist Hospital.

“Untreated, asthma is a very high-risk disease. It can be very dangerous,” he said. “But when it is treated, people with asthma can do very well. They are not limited in any way, and can have a completely normal life with all kinds of physical activity, including participation in sports.”

Asthma is particularly risky as people age, another important reason to seek diagnosis and treatment. Severe asthma attacks may require emergency room visits and hospitalization, and they can be fatal. Almost 3,600 people die of asthma each year, nearly half of whom are age 65 or older, according to the CDC.

“Adults are four times more likely to die of asthma than children,” Dr. Pérez-Fernández said. “It’s very avoidable. With the advances of the past 20 years, we do have the means to treat and control asthma.”

No one knows exactly what causes asthma. Among children, there appears to be a strong connection to allergies and genetics. Adults may also develop the condition due reflux, obesity, certain medications, respiratory illness or flu, and exposure to chemicals and environmental factors.

Some adults may develop occupational asthma, a condition triggered by irritants in their workplace. Aspirin-sensitive asthma is another type that is seen in adults. Adults who are overweight or obese are at greater risk, possibly because of the low-grade inflammation in the body that occurs with extra weight.

Not everyone who has asthma will experience the classic wheezing, Dr. Pérez-Fernández said. Here are some symptoms you should note:

• Dry Coughing. You don’t feel sick, but you just can’t stop coughing — and over the counter medicines don’t help. That annoying dry cough may be due to asthma. Called cough-variant asthma, it may account for as many as a third of people who have a chronic cough, according to the American College of Allergy, Asthma & Immunology. The coughing is often a problem at night or in the morning, although some people report asthma-related coughing that is brought on by laughing or even talking.
• Sleep Disturbances. If you wake up frequently at night, it could be asthma. During sleep, the airways often narrow, which can cause an increased resistance to airflow, according to the National Sleep Foundation. Among people who have asthma, the night can pose particular problems with coughing or struggling to breathe. Researchers are trying to determine whether this is due to circadian rhythms, hormonal changes during sleep, lying in a prone position, nighttime post-nasal drip, or a combination of factors. Regardless of the reason, you should mention sleep concerns to your doctor. Too-little sleep can harm your health and make asthma worse.
• Frequent yawning or sighing. These habits don’t necessarily mean you’re bored, tired or exasperated. They may, in fact, be symptoms of asthma. Yawning and sighing are ways to draw more oxygen into your body and push more carbon dioxide out. These behaviors could signal your body’s unconscious effort to solve imbalances caused by constricted airways.
• Heartburn. Acid reflux is a daily fact of life for one out of five Americans. What many people don’t realize is that when stomach acid backs up into your esophagus, it can irritate your airways and cause asthma. “Reflux and asthma go together hand in hand,” said Dr. Pérez-Fernández. If you have reflux, talk to your doctor about strategies to control it, and pay attention to how it may be affecting your respiratory function.
• Fatigue. Asthma limits your body’s ability to efficiently collect oxygen, and that can make you feel tired. Even mild exertion can feel exhausting. Don’t assume you’re just out of shape. While there are many reasons you may feel low energy, you should always mention to your doctor if you’re grappling with unusual fatigue, even if you don’t think it is asthma.
• Chest Pain. Chest pain is always a reason for concern. But it’s not always a cardiac issue. If you feel like something is squeezing or sitting on your chest, it could be a symptom of asthma. Among patients admitted to the hospital for asthma attacks, 78 percent experienced chest pain that was worsened by coughing, inhaling deeply and moving, according to the National Heart, Lung and Blood Institute. If you have chest tightness or pain, see your doctor. If you suspect you are having a heart attack, head immediately to the hospital.

Because some of these symptoms can be progressive, many patients don’t take notice and fail to mention them to their doctor — which is a mistake.

“Don’t dismiss your symptoms. If you find yourself short of breath, don’t blame your age, or that extra weight you might have put on. Tell your doctor, even if you think it’s nothing,” Dr. Pérez-Fernández advises. “If it’s asthma, your doctor will determine your treatment plan based on the severity of your symptoms, triggers, and your lifestyle.”