Phenotypes, Risk Factors, and Mechanisms of Adult-Onset Asthma

Mediators Inflamm. 2015;2015:514868. doi: 10.1155/2015/514868. Epub 2015 Oct 11.


Asthma is a heterogeneous disease with many phenotypes, and age at disease onset is an important factor in separating the phenotypes. Genetic factors, atopy, and early respiratory tract infections are well-recognized factors predisposing to childhood-onset asthma. Adult-onset asthma is more often associated with obesity, smoking, depression, or other life-style or environmental factors, even though genetic factors and respiratory tract infections may also play a role in adult-onset disease. Adult-onset asthma is characterized by absence of atopy and is often severe requiring treatment with high dose of inhaled and/or oral steroids. Variety of risk factors and nonatopic nature of adult-onset disease suggest that variety of mechanisms is involved in the disease pathogenesis and that these mechanisms differ from the pathobiology of childhood-onset asthma with prevailing Th2 airway inflammation. Recognition of the mechanisms and mediators that drive the adult-onset disease helps to develop novel strategies for the treatment. The aim of this review was to summarize the current knowledge on the pathogenesis of adult-onset asthma and to concentrate on the mechanisms and mediators involved in establishing adult-onset asthma in response to specific risk factors. We also discuss the involvement of these mechanisms in the currently recognized phenotypes of adult-onset asthma.

Publication types

  • Review

MeSH terms

  • Age of Onset
  • Air Pollutants
  • Alcohol Drinking
  • Animals
  • Asthma / complications
  • Asthma / pathology*
  • Depression / complications
  • Depression / pathology
  • Environment
  • Female
  • Gonadal Steroid Hormones / metabolism
  • Humans
  • Inflammation / pathology
  • Life Style
  • Male
  • Obesity / complications
  • Occupational Exposure
  • Oxidative Stress
  • Phenotype
  • Respiratory Tract Infections / complications
  • Respiratory Tract Infections / pathology
  • Rhinitis / complications
  • Risk Factors
  • Sex Factors
  • Sinusitis / complications
  • Smoking


  • Air Pollutants
  • Gonadal Steroid Hormones