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In this study, we compared symptoms, comorbidities, and healthcare burden between childhood-onset asthma (< 18 years) and early adult-onset (18–39 years) and late adult-onset asthma (≥ 40 years). Among 3546 participants with data on physician-diagnosed asthma and onset age, 46.4% were defined as adult-onset [864 (24.4%) had early adult-onset asthma (18–39 years) and 782 (22.1%) had late adult-onset asthma (≥ 40 years)], which, compared to childhood-onset asthma, presented with more complex, multi-symptom profiles, including productive cough, sputum production, but less wheezing. Allergy-related comorbidities were more common in childhood-diagnosed asthma, while chronic obstructive pulmonary disease (COPD), diabetes mellitus, hypertension, obesity, and chronic sinusitis were more common in adult-onset asthma. Adult-onset asthma also had a higher disease burden, with more frequent medication use and exacerbations. Adult-onset asthma has an underlying complexity, contributing to a vicious cycle of worsening symptoms, increased medication use, and more comorbidities.