Asthma is often thought of as a childhood condition, but it can start at any age, and millions of American adults live with it. Adult-onset asthma is sometimes missed or mistaken for bronchitis or simply being out of shape. With the right treatment plan, most adults with asthma can control their symptoms and live without limits.
What asthma is
Asthma is a long-term condition in which the airways become inflamed and overly sensitive. When exposed to triggers, the muscles around the airways tighten, the lining swells and extra mucus forms, narrowing the airways and making breathing difficult.
Symptoms
- Wheezing, a whistling sound when breathing out
- Shortness of breath
- Chest tightness
- Coughing, especially at night, early in the morning or with exercise
Symptoms often come and go and may be worse at certain times of year. Some adults have mainly a persistent dry cough (cough-variant asthma).
Common triggers
- Respiratory infections such as colds and flu
- Allergens: pollen, dust mites, mold, pet dander and cockroaches
- Cold air and changes in weather
- Exercise
- Smoke, including cigarette smoke and wildfire smoke
- Air pollution
- Strong smells, perfumes and cleaning products
- Workplace exposures (occupational asthma)
- Some medicines, such as aspirin and other NSAIDs in sensitive people, and certain beta blockers
- Acid reflux
- Stress and strong emotions
How asthma is diagnosed
Doctors combine your symptoms with breathing tests:
- Spirometry before and after using a bronchodilator; improvement after the inhaler supports asthma
- Peak flow monitoring at home to track variation over time
- FeNO testing, which measures a gas in your breath linked to airway inflammation
- Bronchial challenge tests in some cases
- Allergy testing to identify triggers
Understanding asthma inhalers
Controller (preventer) inhalers
These reduce airway inflammation over time and are the foundation of treatment for most adults with persistent asthma. The main medicine is an inhaled corticosteroid (such as budesonide or fluticasone), often combined with a long-acting bronchodilator.
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Reliever (rescue) inhalers
These quickly open the airways during symptoms. The traditional reliever is albuterol.
Why guidelines have changed
International guidelines (GINA) now advise against treating adult asthma with a short-acting reliever like albuterol alone, because relying only on rescue inhalers without anti-inflammatory treatment increases the risk of severe attacks.
Instead, many adults are now prescribed budesonide-formoterol as both their daily controller and their reliever, an approach called SMART or MART (single maintenance and reliever therapy). For milder asthma, budesonide-formoterol may be used just as needed. Another option is an inhaler that combines albuterol with budesonide for rescue use. These approaches reduce severe attacks compared with albuterol alone.
Ask your doctor which plan is right for you and how many puffs to use.
Using inhalers correctly
Many people do not get the full dose because of poor technique. Ask a nurse or pharmacist to watch you use it, use a spacer with metered-dose inhalers if advised, and rinse your mouth after inhaled steroids to prevent thrush.
Severe asthma
If asthma stays uncontrolled despite correct use of high-dose inhalers, you may have severe asthma. A specialist can assess you for biologic medicines, injections such as omalizumab, mepolizumab, benralizumab, dupilumab and tezepelumab, which target specific inflammation pathways and can dramatically reduce attacks and steroid use.
Your asthma action plan
Every adult with asthma should have a written action plan from their doctor that explains:
- Daily medicines
- How to recognize worsening asthma
- What to do and how much medicine to take in a flare
- When to seek emergency care
Warning signs of a severe attack
Call 911 if:
- You are very short of breath and cannot speak in full sentences
- Your reliever is not helping or you need it every few minutes
- Your lips or fingernails look blue or gray
- You feel drowsy, confused or exhausted
- Your peak flow is below 50 percent of your personal best
Living well with asthma
- Take controller medicine regularly, even when you feel well
- Know and avoid your triggers where possible
- Stop smoking and avoid smoke
- Get flu, COVID-19, pneumococcal and RSV vaccines as recommended
- Stay active; with good control, most people can exercise normally
- See your doctor at least once a year to review your plan, or sooner if you use your reliever more than twice a week
The bottom line
Asthma can begin in adulthood and is very treatable. If you have recurring wheezing, coughing or breathlessness, ask about breathing tests. Modern treatment relies on anti-inflammatory inhalers rather than rescue inhalers alone, and a written action plan helps you stay in control.
This article is for general information and does not replace medical advice.