Regardless of when it starts, keeping up with medication is a must to keep symptoms at bay.
"You need to get in and use your hands," says James Chevalier of Middletown, Delaware.
Restoring old cars helps him decompress from a very demanding profession.
Most of the time, he's "Pastor Jim," leading the Oasis Church in Newark, Delaware.
And he uses the power of his voice to inspire his congregation.
Six or seven years ago, shortness of breath made delivering a sermon, or even time around the house, a struggle.
It was asthma.
"I could work in 15-minute increments and then have to sleep for an hour," he recalls.
Adult-onset asthma can be triggered by allergies, chronic reflux, colds or flu, hormonal changes, or airborne irritants -
'Things like dust and mold, or diesel fuel, or cigarette smoke," says Susan Estrella-Eades, a pulmonary nurse practitioner at the Temple Lung Center.
She adds adult asthma is more likely to also involve eosinophils, white blood cells which cause swelling in the entire respiratory system, not just the bronchial tubes.
James says traditional drugs like inhalers prescribed by his first doctors didn't work well with eosinophilic asthma, but when he got to Temple, doctors recommended new drugs called biologics.
Those drugs (Fasenra, Dupixent, Nucala and Cinqair) can block swelling by reducing the number of eosinophils in the blood or by blocking them from causing the inflammation.
"That could potentially help give control of their asthma, and, in some cases, improve their lung function a bit," says Estrella-Eades.
As an asthma patient herself, she says having a daily treatment plan, an action plan for emergencies, and taking medications on schedule keeps people out of the ER.
She says an asthma diary, or at least taking a few notes, can help.
"Be aware of your symptoms on a daily basis," she notes.
"What makes them feel better? What makes them feel worse?" she adds.
Chevalier says getting to Temple for the right diagnosis and treatment and staying on schedule keeps him with his congregation.
"I have to get an injection every 8 weeks," but he responded to the biologic right away, adding, "Within 15 minutes of the first injection, my lungs opened up."
The biologic drugs can be expensive, the Temple Lung Center and the drug-makers will work with patients so they can get the medications.
"I have nothing but praise for (Temple) and the folks that made Fasenra," he says. "Astra Zeneca has helped me with the financial burden."
Estrella-Eades says patients often tell her they're too busy to keep up with their medications.
But uncontrolled asthma can chip away at overall health, and that means time lost being in urgent care - or the hospital.
Chevalier says he doesn't have to hold back on his sermons, knowing his breathing and voice can keep up now.
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