Asthma is one of the three most common long-term health conditions in Australia, according to the 2021 Census, behind only mental illness and arthritis.
While the condition is most common in childhood up to age 14, asthma can emerge at any age, even in a person’s 50s, 60s and 70s. This is known as adult-onset asthma.
Anthony Flynn, Senior Manager of Research, Information and Evaluation at Asthma Australia, says adult-onset asthma is relatively uncommon compared with asthma onset in childhood, and as a result, it tends to slip under the radar.
“There’s an inherent bias that asthma onset occurs in childhood and adolescence, and largely not in adults, so perhaps some health professionals aren’t looking out for it,” he said.
Ageing bodies are also prone to a variety of conditions that may mask asthma suspicions – even from the sufferers themselves.
“In adulthood, we’re presented with a range of things in terms of how our bodies change and other chronic diseases that appear to distract us from the changes that we’re experiencing with our breathing and in our respiratory system, so it may not occur to us to get attention, or may not be as important [to the individual] in the context of the overall circumstances in their life,” Mr Flynn said.
“Also, I think in adulthood we’re less likely to be help-seekers. In childhood, we’re under the care of our parents, who pick up on changes. But in adulthood, we’re a bit more independent, and less likely, in general, to seek healthcare.”
Case study
Asthma Australia recently shared the story of Mary Keller from Tasmania, who was first diagnosed with asthma at the age of 72.
“It was never in our family, I never had it as a child or anything, and it was totally unexpected,” Ms Keller said of the diagnosis.
“I just noticed a couple of years ago, when I walked uphill, I was puffed, when I walked up the stairs, I was puffing, and when I was doing a bit of gardening, puff puff, and I thought, ‘Heavens, maybe there’s something wrong with my heart’.”
A visit to her doctor, who tested her lung function, confirmed that she had asthma.
“I was surprised,” Ms Keller said, “and I thought, ‘Why am I getting it now, in my dotage?’”
Ms Keller was prescribed a reliever, which she uses as needed, and a preventer for morning and night. This helps reduce her risk of flare-ups – and as for environmental triggers, she avoids those, such as cold air and smoke, as best she can.
Differences
A key difference between child- and adult-onset asthma, says Mr Flynn, is that the latter is much more difficult to control.
“It’s associated with a high risk or more frequent complications, persistent poor control, or asthma that’s difficult to get under control,” he said of the later-life version. “It’s also associated with asthma that results in faster decline in the health of lungs.
“That deterioration in lung function is typically something that, if diagnosed, should have us, as peak organisations and health professionals around people with asthma, paying careful attention to their needs, and to tailor treatments specifically to the needs of people with adult-onset asthma.”
In terms of risk factors for developing adult-onset asthma, Mr Flynn says occupational exposure is among the biggest, accounting for 10 to 20 per cent of cases.
Other factors increasing risk of adult-onset asthma include smoking, obesity, chronic rhinitis, sinusitis and upper airway allergies.
Role of pharmacists
Asthma Australia recommends that anyone who gets out of breath often, but particularly adults aged over 50, should not accept this as a ‘normal part of ageing’, and should talk to a health professional.
Pharmacists, as generally the most common point of contact for patients and customers, have an important role to play in supporting adults with asthma, including those not yet diagnosed.
“Through their relationship with customers, pharmacists can identify where people may be experiencing breathlessness, or symptoms that mimic asthma,” Mr Flynn said, adding that they should provide information that encourages customers not to dismiss these symptoms.
“I think pharmacists could play a great role writing referrals for their customers to health professionals, such as GPs or specialists, to investigate a customer’s breathlessness, and then once diagnosed, the mainstay of treatment for almost all people with adult-onset asthma will be at least an inhaled corticosteroid-based preventive medicine, if not more therapy, so pharmacists play a key role in supporting the quality and use of those medicines.”
Pharmacists can access Asthma Australia’s extensive health professional resources to assist their patients in managing asthma by visiting asthma.org.au/health-professionals/health-professional-resources.
This feature was originally published in the October issue of Retail Pharmacy magazine.
