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Adults, especially by middle age, may have stiffening of the chest wall, which can make treating asthma more difficult. Adults are also at a higher risk of death due to asthma than children. In , 3, people died from asthma. Almost all of these people were over 18 years old. The reasons why adults have a higher rate of asthma-related death are not clear. It may be because symptoms tend to be less well-controlled than children or because of a delay in diagnosis.
It is vital to get an accurate diagnosis of adult-onset asthma in order to develop the most effective treatment plan. In many cases, adult-onset asthma takes longer to diagnose than asthma in childhood. This is partly due to confusion with other conditions that occur in adults but are rare in children. For example, asthma that develops in adulthood is sometimes confused with chronic obstructive pulmonary disease COPD.
Doctors can diagnose adult-onset asthma through a physical exam, medical history, and lung-function tests. A lung-function test involves a series of breathing tests that measure how much air a person can inhale and exhale.
People can treat adult-onset asthma with a combination of lifestyle changes and medications. Everyone has their own treatment plan for asthma. Adults are more likely than children to have other medical conditions as well, which is a consideration when developing an asthma treatment plan. Treatment for most types of asthma includes bronchodilators. Different types of bronchodilators are available, including long-acting and fast-acting ones. Both types can play a role in the management of asthma.
Fast-acting bronchodilators, such as albuterol , work by relaxing the muscles of the airways. As the muscles relax, the airways widen, making breathing easier. People take fast-acting bronchodilators via an inhaler or through a nebulizer. The medications reduce sudden symptoms, such as wheezing and shortness of breath. People can also use long-acting bronchodilators to manage adult-onset asthma.
These drugs also relax the airways, but they last longer than fast-acting inhalers. Instead of treating sudden symptoms, they prevent symptoms. In some instances, people can also use inhalers that contain corticosteroids to treat adult-onset asthma.
Steroids decrease airway inflammation. Inhalers that contain corticosteroids do not treat sudden symptoms. Instead, they decrease the frequency of symptoms. In some cases, treatment includes oral steroids.
These include exposure to sensitising or irritant substances, obesity, pharmaceuticals, rhinitis, environmental pollutants, respiratory tract infections and psychological stress. Initially, symptoms usually abate when not at work eg weekends , but become more persistent with continued exposure.
The onset of symptoms may also be delayed for a number of hours. Therefore, symptoms experienced after work eg the evening or at night may represent a delayed response to an occupational exposure. Obesity and asthma are common disorders in the Australian community, and the latter has become more prevalent in past 20 years.
Beta-blocking eye drops used in the treatment of glaucoma may cause wheezing, chest tightness or breathlessness in sensitive individuals. Rhinitis is a risk factor in the development of asthma in non-atopic and atopic adults. Environmental pollutants, and active and passive tobacco smoking have long been recognised as trigger factors in people with asthma. It is less well recognised that cigarette smoking is a risk factor for the development of asthma in individuals aged 7—33 years.
Stress has also been shown to have a significant association with the occurrence of asthma and hospitalisation in young adults. The clinical presentation of asthma in adults is usually straightforward, and complaints of shortness of breath, cough, wheezing and chest tightness are common.
Coughing in isolation is usually associated with an infection, but the diagnosis of asthma should be considered if it is accompanied by wheezing, particularly at night.
Recurrent respiratory tract infection should always raise the possibility of poorly controlled asthma. As with other age groups, exercise-induced asthma needs to be considered in cases of breathlessness on exertion.
Shortness of breath on exertion, and complaints of wheezing and coughing in the night should also alert the clinician to the possible alternative diagnosis of ischaemic heart disease, even in the absence of exercise-induced chest pain or discomfort.
Enquiries should be made about precipitating and aggravating factors, and any relieving factors eg use of bronchodilators. A family or past or concurrent history of atopy and a smoking history should be sought.
Asthma that presents for the first time in cigarette smokers with established chronic airflow limitation may be difficult to detect or differentiate from chronic obstructive pulmonary disease COPD. Other conditions with similar symptoms need to be considered. This includes cardiac disease, pulmonary hypertension, poor cardiopulmonary fitness and other respiratory conditions. Laryngeal disorders eg vocal cord dysfunction syndrome should be considered in those who present with normal expiratory spirometry, appear well and who have an upper airway stridor.
Symptoms of asthma may be the presenting features in some other conditions. Nocturnal wheeze may be due to gastro-oesophageal reflux, particularly when associated with cough. Churg-Strauss syndrome may present as severe asthma in adults. In general, asthma is more likely to be the explanation if the presenting symptoms are recurrent or seasonal, worse at night or in the early morning, prompted by recognised triggers and rapidly relieved by short-acting beta-2 agonists.
A reduction in symptoms, and an increase in FEV 1 and peak expiratory flow rate PEFR should be expected following standard asthma therapy. Slow responses to appropriate therapy may occur in those with longstanding, poorly managed asthma as a consequence of airway remodelling resulting in a degree of fixed airways obstruction. Slow responses and absence of improvement should prompt a careful review for alternative diagnoses. In those cases where spirometry is normal or relatively so, bronchial provocation testing should be considered but should only be performed in recognised pulmonary function laboratories.
Induced sputum eosinophil counts and the measurement of expired nitric oxide are undertaken in some centres. However, these are not recommended in routine clinical practice. Spirometry and PEFR remain the first-line measurements in most cases. The management of asthma in adults 1 is based initially on confirming the diagnosis, assessing the symptoms and their control, providing asthma education about the underlying nature of the condition and establishing treatment goals.
In cases of newly diagnosed symptomatic asthma, regular use of low-dose, inhaled corticosteroids, supplemented by the use of inhaled short-acting beta-2 agonists when symptomatic, is appropriate. Regular review should follow to assess progress.
If treatment is effective in achieving good asthma symptom control, then a gradual reduction in dosage should be possible, with the aim of reaching the minimum that controls symptoms. Ongoing review at appropriate intervals is important to ensure good asthma control. Individuals with occupational asthma should avoid the sensitising or triggering agent, but can otherwise be treated in the same way as those with non-work-related asthma.
They may be able to continue their job, providing that exposure to triggers is minimised. This is not possible in some cases. It is recommended that the person be referred to a respiratory specialist who is experienced in managing occupational asthma before considering leaving their job.
Poor treatment responses should prompt re-assessment of inhaler technique and adherence to therapy. The majority of patients do not use their inhaler devices correctly, and clear instructions and regular technique checks are essential.
Strategies should be encouraged to improve adherence. Loss of asthma control may also be associated with respiratory tract infections and exposure to other known irritants and trigger factors.
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