Adult-Onset Asthma Epidemiology and Management

Adult-onset asthma, defined as asthma first diagnosed in individuals over the age of 18 years, represents a substantial and growing proportion of the global asthma burden. Unlike childhood asthma, adult-onset disease often presents with a female predominance, a lower prevalence of allergic sensitisation and a higher incidence of non‐type 2 inflammatory phenotypes. Key risk factors include obesity, smoking, occupational exposures, hormonal changes and coexisting conditions such as rhinitis and gastro-oesophageal reflux. Incidence curves in many populations show a second peak in the fourth decade of life, with non-allergic forms predominating at older ages. Clinically, adult-onset asthma tends to be less remission-prone, more severe and associated with greater health-care utilisation than childhood-onset asthma.

Management of adult-onset asthma requires a phenotype-driven approach. Initial assessment encompasses spirometry, biomarker evaluation (blood eosinophils, exhaled nitric oxide), comorbidity screening and inhaler technique review. Inhaled corticosteroids remain the cornerstone of therapy, often combined with long-acting bronchodilators. Patients with severe eosinophilic or allergic presentations may benefit from targeted biologic agents. Self-management strategies, including personalised asthma action plans, lifestyle modification (weight loss, smoking cessation) and structured follow-up in primary care, are critical to improving control and reducing exacerbations.

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Adult-Onset Asthma Epidemiology and Management publication trend

The graph below shows the total number of articles in adult-onset asthma epidemiology and management across all publications each year (not limited to Nature Index journals).

Technical terms

Adult-onset asthma: Asthma first diagnosed in an individual aged 18 years or older.

Phenotype: A set of observable clinical and biological characteristics that distinguish subtypes of asthma.

Comorbidity: The presence of one or more additional conditions (e.g., rhinitis, obesity) coexisting with asthma.

Eosinophil: A type of white blood cell involved in type 2 airway inflammation, often elevated in allergic asthma.

Inhaled corticosteroids (ICS): Anti-inflammatory medications delivered via inhalation to reduce airway inflammation and prevent exacerbations.

Exacerbation: An acute or subacute worsening of asthma symptoms requiring escalation of treatment.

References

1. Phenotypes, Risk Factors, and Mechanisms of Adult‐Onset Asthma. Mediators of Inflammation (2015).
2. Documentation of comorbidities, lifestyle factors, and asthma management during primary care scheduled asthma contacts. npj Primary Care Respiratory Medicine (2024).
3. Lifetime asthma incidence is related to age at onset and allergies in western Sweden. Clinical and Translational Allergy (2024).
4. Subtypes of Adult-Onset Asthma at the Time of Diagnosis: A Latent Class Analysis. International Journal of Environmental Research and Public Health (2023).