adult-onset severe asthma

Adult-Onset Severe Asthma: A Complex Condition

Adult-onset severe asthma, also known as adult-onset asthma, is a subtype of asthma that develops in adulthood, typically after the age of 20 [10]. This type of asthma can be more severe and associated with a faster decline in lung function compared to childhood-onset asthma [9].

Characteristics of Adult-Onset Severe Asthma

Adult-onset severe asthma often presents with symptoms such as shortness of breath, wheezing, chest tightness or pain, and coughing, especially at night or during exercise [2-5]. These symptoms can be more frequent and impair lung function, making it a more challenging condition to manage.

Key Features

• Non-atopic: Adult-onset severe asthma is often non-atopic, meaning that it is not triggered by allergies [6].
• More severe: This type of asthma tends to be more severe than childhood-onset asthma, with a faster decline in lung function [9].
• Impaired lung function: Adult-onset severe asthma can impair lung function, making it difficult to breathe and perform daily activities.
• Increased risk of hospitalization: Individuals with adult-onset severe asthma are at greater risk of being hospitalized if they contract COVID-19 or experience severe symptoms [14].

Management and Treatment

Managing adult-onset severe asthma requires a comprehensive approach, including:

• Asthma action plan: Developing an asthma action plan to identify triggers and adjust treatment accordingly.
• Medication management: Working with healthcare providers to optimize medication regimens and inhalation techniques.
• Trigger avoidance: Identifying and avoiding triggers that can exacerbate symptoms.

Conclusion

Adult-onset severe asthma is a complex condition that requires careful management and treatment. By understanding its characteristics, key features, and management strategies, individuals can take steps to better control their symptoms and improve their quality of life.

Symptoms of Adult-Onset Severe Asthma

Adult-onset severe asthma can manifest in various ways, making it essential to recognize the signs and symptoms to seek proper medical attention. Here are some common indicators:

• Shortness of breath: A persistent feeling of being unable to catch one's breath, even when sitting still or engaging in light physical activity [1].
• Chest tightness or pain: A squeezing sensation in the chest that can be uncomfortable and may worsen with deep breathing or coughing [2].
• Wheezing: A high-pitched whistling sound while exhaling, which is a common sign of asthma in adults [3].
• Difficulty sleeping: Asthma symptoms can disrupt sleep patterns, making it challenging to fall asleep or stay asleep throughout the night [4].
• Dry cough: A persistent and dry cough that may worsen at night or in the early morning hours [5].
• Increased mucus secretion: Excessive production of mucus in the airways, which can lead to a feeling of congestion or stuffiness [6].

Severe Asthma Symptoms

In cases where asthma symptoms are severe, it's crucial to seek emergency care. These include:

• Peak flow readings below 50%: A significant drop in lung function, indicating severe asthma [7].
• Quick-relief medicine not helping: If medications are not providing relief from symptoms, it may be a sign of severe asthma that requires immediate attention [8].

Recognizing the Signs

It's essential to recognize these signs and symptoms early on to prevent complications. Daily monitoring of symptoms and adherence to medication regimens can help manage adult-onset severe asthma.

References:

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Diagnosing Adult-Onset Severe Asthma

Adult-onset severe asthma can be a challenging condition to diagnose, as it often presents with symptoms that are similar to other respiratory conditions. However, there are several diagnostic tests and procedures that healthcare professionals use to confirm the presence of adult-onset severe asthma.

• Medical History: A thorough medical history is essential in diagnosing adult-onset severe asthma. Your doctor will ask about your symptoms, such as wheezing, coughing, shortness of breath, and chest tightness, as well as any triggers that may exacerbate these symptoms [1].
• Physical Exam: A physical exam can also help identify signs of asthma, such as a wheeze or a cough when you breathe out [2].
• Lung Function Tests: Lung function tests, such as spirometry and peak flow metering, are used to measure the amount of air that can be breathed in and out of the lungs. These tests can help confirm the presence of asthma by showing reduced lung function [3].
• Challenge Tests: Challenge tests, such as a methacholine challenge test, can also be used to diagnose asthma. During this test, you will breathe in a medication that causes your airways to constrict, and then your lung function will be measured [4].

Occupational Exposures

In some cases, adult-onset severe asthma may be caused by occupational exposures, such as working with chemicals or dust. If you have symptoms of asthma and work in an environment where you are exposed to potential allergens, it is essential to inform your doctor about this [5].

Allergist Evaluation

An allergist can also evaluate you for adult-onset severe asthma using various tests, including skin prick testing and blood tests, to determine if you have allergies that may be contributing to your symptoms [6].

Summary of Diagnostic Tests

To diagnose adult-onset severe asthma, your doctor will typically ask about your medical history, perform a physical exam, and conduct lung function tests. They may also use challenge tests or refer you to an allergist for further evaluation.

References:

[1] Context 2 [2] Context 9 [3] Context 3 [4] Context 3 [5] Context 6 [6] Context 7

Treatment Options for Adult-Onset Severe Asthma

Adult-onset severe asthma can be challenging to manage, but various treatment options are available to help control symptoms and improve quality of life.

• Oral Medications: Oral medications such as montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo) can help relieve asthma symptoms [1].
• Oral Steroids: Oral corticosteroids are used to treat acute asthma flares and are usually prescribed for short periods of time (5-7 days) [3]. They work by reducing inflammation and helping other medications work better.
• Bronchodilators: Fast-acting bronchodilators, such as albuterol, can help relax the muscles of the airways, widening them and making breathing easier [8].
• Combination Therapy: Combination therapy with a SABA (short-acting beta agonist) and an inhaled corticosteroid (ICS), such as Airsupra, may be beneficial for treating acute asthma symptoms and preventing future attacks [7].

Additional Treatment Options

In severe cases of adult-onset asthma, additional treatment options may be considered:

• Biologics: Biologic medications like dupilumab (Dupixent) can help block the action of IL-4 and IL-13, reducing inflammation and improving symptoms in people with severe eosinophilic asthma [6].
• Pharmacotherapy and Non-Drug Treatment: A combination of pharmacotherapy and non-drug treatment, including patient education, exercise, smoking cessation, and rehabilitation, can help achieve good asthma control [4].

It's essential to work closely with a healthcare provider to determine the best course of treatment for adult-onset severe asthma. They will consider individual factors, such as symptoms, medical history, and medication tolerance, when developing a personalized treatment plan.

References:

[1] Apr 6, 2024 - These oral medications — including montelukast (Singulair), zafirlukast (Accolate) and zileuton (Zyflo) — help relieve asthma symptoms. [3] Oral corticosteroids are used to treat acute asthma flares. They are usually prescribed only for short periods of time (5-7 days). [4] by M Lommatzsch · 2020 · Cited by 54 — This can be achieved with a combination of pharmacotherapy and non-drug treatment including patient education, exercise, smoking cessation, and rehabilitation. [6] Aug 20, 2024 — People with severe eosinophilic asthma may benefit from a medication called dupilumab (brand name: Dupixent) that blocks the action of IL-4 and ... [7] Oct 1, 2023 — Airsupra is a combination of a SABA and an inhaled corticosteroid (ICS) for the treatment of acute asthma symptoms and the prevention of future ... [8] Fast-acting bronchodilators, such as albuterol, work by relaxing the muscles of the airways. As the muscles relax, the airways widen, making breathing easier.

Differential Diagnosis of Adult-Onset Severe Asthma

Adult-onset severe asthma can be challenging to diagnose, and a broad differential diagnosis is essential to ensure that other conditions are not missed. Here are some key points to consider:

• Vocal cord dysfunction or inducible laryngeal obstruction (ILO): This condition may exist alone or with asthma and can cause paradoxical adduction of the vocal cords during inspiration, leading to symptoms similar to asthma [1].
• Cardiac failure: Dyspnea due to cardiac failure is a common and important differential diagnosis for adult-onset asthma and COPD in the elderly, including acute exacerbations [7].
• Bronchiectasis: This condition can cause cough, dyspnea unresponsive to bronchodilator or corticosteroid, recurrent pneumonia, and high-resolution CT of the chest findings [9].
• Non-allergic asthma: Adult-onset asthma is often non-atopic, more severe, and associated with a faster decline in lung function compared to childhood-onset asthma [8].
• Other conditions: A thorough differential diagnosis should also consider other conditions such as COPD, bronchiectasis, and cardiac failure.

Key Considerations

When diagnosing adult-onset severe asthma, it is essential to:

• Maintain a high index of suspicion for asthma mimickers, especially when patients fail to respond to conventional therapy [3].
• Perform a detailed history with supportive pulmonary function tests to properly diagnose asthma [2].
• Consider the patient's age, sex, and comorbidities in the differential diagnosis.
• Use a broad differential diagnosis approach to ensure that other conditions are not missed.

References

[1] Context result 1 [7] Context result 7 [8] Context result 8 [9] Context result 9