AFAIK it's (in part) a hormonal thing? Testosterone-fueled puberty tends to improve asthma symptoms and estrogen-fueled puberty worsens them. There is some evidence base for this being a phenomenon but I don't have any references handy. I haven't seen anyone give a mechanical basis for it either, but it can happen.
My own asthma went from being crippling to an inconvenience after puberty #1 and stayed an inconvenience until puberty #2 when it worsened somewhat again. It's never been as bad as it was when I was a kid since puberty #1 though.
Current Global Initiative for Asthma treatment guidelines for asthma recommend avoiding rescue inhaler use as much as possible, managing it as an inflammatory airway condition with inhaled corticosteroids and adding scheduled long-acting beta agonists if symptoms aren't well-controlled. Albuterol overuse can worsen symptoms over the long run.
Sources to come if I can find them and have the time!
This is gonna be a wild one, TY to @CommunistCuddlefish@hexbear.net for helping to put this together!
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