Asthma symptoms in adults
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Asthma Symptoms in Adults: An Overview
Prevalence and Trends in Asthma Symptoms
Changes in Symptom Prevalence Over Time
Asthma symptoms in adults have shown varying trends over the past decades. A longitudinal study conducted across Europe and Australia found that the prevalence of wheezing and wheezing without a cold decreased over a 20-year period. However, there was an increase in the prevalence of asthma attacks, use of asthma medication, and hay fever/nasal allergies. This decrease in wheezing was largely attributed to smoking cessation rather than improvements in asthma treatment.
Asthma Diagnosis and Misdiagnosis
Asthma diagnosis in adults is primarily clinical, based on symptoms such as wheezing, cough, chest tightness, and dyspnea, along with evidence of variable and reversible airflow obstruction. However, there is a significant issue with misdiagnosis due to the variability of symptoms and the complexity of asthma phenotypes. Misdiagnosis can lead to unnecessary medication use and missed opportunities to treat the actual cause of respiratory symptoms.
Factors Influencing Asthma Symptoms
Role of Respiratory Infections
Respiratory viruses play a significant role in exacerbating asthma symptoms in adults. Studies have shown that colds and respiratory infections are commonly associated with asthma exacerbations, leading to significant reductions in peak expiratory flow rates. Infections with viruses such as rhinoviruses, coronaviruses, and influenza B are particularly linked to worsening asthma symptoms.
Impact of Smoking and Atopy
Smoking cessation has been shown to reduce wheezing and other asthma-like symptoms significantly. Additionally, atopy, which includes conditions like hay fever and nasal allergies, influences the prevalence and severity of asthma symptoms. Reductions in atopy with aging may also contribute to the observed decrease in wheezing among older adults.
Symptom Burden and Quality of Life
Patient Perception of Symptoms
The burden of asthma symptoms varies among patients. A study using conjoint analysis revealed that adults with asthma rated daytime cough and breathlessness as more troublesome compared to wheeze, chest tightness, or sleep disturbance. This indicates that cough and breathlessness have a greater impact on the quality of life for many patients.
Correlation Between Symptoms and Airway Obstruction
Interestingly, the severity of asthma symptoms does not always correlate with the degree of airway obstruction. Studies have found that symptoms like wheezing and chest tightness may improve subjectively without corresponding improvements in objective measures of airway obstruction, such as FEV1 and peak expiratory flow. This highlights the importance of objective measurements in managing asthma.
Long-Term Outcomes and Phenotypes
Transition from Childhood to Adulthood
Asthma often begins in childhood, but its course can change over time. Some children outgrow their symptoms during adolescence, while others continue to experience asthma into adulthood. Factors such as genetics, early-life infections, and allergic diseases influence these outcomes. Additionally, new-onset asthma symptoms in adulthood are more common in women and those with impaired lung function.
Potential for Symptom Remission
There is evidence that some adults may outgrow their asthma. A long-term follow-up study found that a subset of adults no longer exhibited bronchial hyperresponsiveness or reported pulmonary symptoms after 25 years. Factors associated with a favorable outcome included younger age at initial diagnosis and less severe airway obstruction.
Conclusion
Asthma in adults is a complex condition influenced by various factors, including respiratory infections, smoking, and atopy. While some adults may experience a reduction in symptoms over time, others continue to face significant challenges. Accurate diagnosis and management, considering both subjective symptoms and objective measures, are crucial for improving outcomes and quality of life for adults with asthma.
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