Late onset asthma
DOI: 10.32364/2587-6821-2025-9-8-4
V.V. Gaynitdinova, T.U. Bogatyreva, S.N. Avdeev
I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
Asthma is a heterogeneous disease characterized by chronic airway inflammation and respiratory symptoms such as episodes of dyspnea, breathlessness, wheezing, dyspnea, chest tightness, and cough, which vary in time and intensity and are accompanied by variable airway obstruction. The heterogeneity of asthma is reflected by the presence of distinct disease phenotypes, many of which can be identified in routine clinical practice. According to recent studies, one of the most prevalent phenotypes in Russia is eosinophilic late-onset asthma. The term "late-onset asthma" refers to a condition in which asthma-like symptoms first appear in individuals over the age of 40. Approximately 30–40% of adult patients with asthma report their initial symptoms after the age of 40. Furthermore, up to 52% of patients with asthma experience their first asthmatic episode after reaching the age of 40. The major phenotypes of late-onset asthma include non-allergic eosinophilic and non-eosinophilic forms, which differ in their pathobiological mechanisms and clinical presentations. Particular attention should be paid to the challenges in diagnosis and differential diagnosis, compounded by age-related changes in the lungs, similarities of symptoms with COPD, cardiovascular and other diseases, and the complexities of management. This article systematizes current data on late-onset asthma and outlines directions for future research.
Keywords: late-onset bronchial asthma, asthma phenotypes, eosinophilic inflammation, non-eosinophilic inflammation, immunosenescence, comorbidity.
For citation: Gaynitdinova V.V., Bogatyreva T.U., Avdeev S.N. Late onset asthma. Russian Medical Inquiry. 2025;9(8):454–462 (in Russ.). DOI: 10.32364/2587-6821-2025-9-8-4
About the authors:
Viliya V. Gaynitdinova — Dr. Sc. (Med.), Professor at the Pulmonology Department of the Institute of Clinical Medicine of the N.V. Sklifosovskiy, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, build. 2, Trubetskaya str., Moscow, 119048, Russian Federation; ORCID iD 0000-0001-9928-926Х
Tamara U. Bogatyreva — postgraduate student at the Pulmonology Department of the Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, build. 2, Trubetskaya str., Moscow, 119048, Russian Federation; ORCID iD 0009-0005-0348-1772
Sergey N. Avdeev — Dr. Sc. (Med.), Professor, Academician of the Russian Academy of Sciences, Head of the Department of Pulmonology at the Institute of Clinical Medicine of the N.V. Sklifosovskiy, Director of the Scientific Research Institute of Pulmonology of the I.M. Sechenov First Moscow State Medical University (Sechenov University); 8, build. 2, Trubetskaya str., Moscow, 119048, Russian Federation; ORCID iD 0000-0002-5999-2150
Contact information: Tamara U. Bogatyreva, e-mail: bogatireva001@mail.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 03.07.2025.
Revised 28.07.2025.
Accepted 20.08.2025.
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4. Anandan C., Nurmatov U., van Schayck O.C., Sheikh A. Is the prevalence of asthma declining? Systematic review of epidemiological studies. Allergy. 2010;65(2):152–167. DOI: 10.1111/j.1398-9995.2009.02244.x
5. Wu B.C., Chang C.H., Tsai Y.C. et al. Different Characteristics and Clinical Outcomes between Early-Onset and Late-Onset Asthma: A Prospective Cohort Study. J Clin Med. 2022;11(24):7309. DOI: 10.3390/jcm11247309
6. Jenkins M.A., Hopper J.L., Bowes G. et al. Factors in childhood as predictors of asthma in adult life. BMJ. 1994;309(6947):90–93. DOI: 10.1136/bmj.309.6947.90
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8. Leynaert B., Sunyer J., Garcia-Esteban R. et al. Gender differences in prevalence, diagnosis and incidence of allergic and non-allergic asthma: a population-based cohort. Thorax. 2012;67(7):625–631. DOI: 10.1136/thoraxjnl-2011-201249
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10. Labor M., Labor S., Jurić I. et al. Mood disorders in adult asthma phenotypes. J Asthma. 2018;55(1):57–65. DOI: 10.1080/02770903.2017.1306546
11. Abreu S.C., Antunes M.A., Xisto D.G. et al. Bone Marrow, Adipose, and Lung Tissue-Derived Murine Mesenchymal Stromal Cells Release Different Mediators and Differentially Affect Airway and Lung Parenchyma in Experimental Asthma. Stem Cells Transl Med. 2017;6(6):1557–1567. DOI: 10.1002/sctm.16-0398
12. Kaur R., Chupp G. Phenotypes and endotypes of adult asthma: Moving toward precision medicine. J Allergy Clin Immunol. 2019;144(1):1–12. DOI: 10.1016/j.jaci.2019.05.031
13. Moore W.C., Meyers D.A., Wenzel S.E. et al. Identification of asthma phenotypes using cluster analysis in the Severe Asthma Research Program. Am J Respir Crit Care Med. 2010;181(4):315–323. DOI: 10.1164/rccm.200906-0896OC
14. Simpson J.L., Scott R., Boyle M.J., Gibson P.G. Inflammatory subtypes in asthma: assessment and identification using induced sputum. Respirology. 2006;11(1):54–61. DOI: 10.1111/j.1440-1843.2006.00784.x
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