Fawzia abo ali
Prof. of int. medicine & clinical immunology Faculty of medicine Ain shams university

Asthma is a chronic inflammatory airway disease that has a higher prevalence in boys than in girls before puberty and a higher prevalence in women than in men in adulthood. Because of the complexity of the disease, no single straightforward mechanism can explain the gender differences found in asthma.

Asthma & Gender

Before puberty, asthma occurs more often in males, but after adolescence, it appears to be more common in females. At adolescence, girls have greater likelihood of new onset asthma, while many boys “grow out” of asthma In adults with similar cases of actual airway obstruction, women are likely to report more severe symptoms than men are.

Age and asthma - male : female ratio
Age frequent episodic 7 12 2.1 2.1

21 28

1.5 1.3

Women and asthma

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Many diseases more common/severe in women (ie, Lupus, Rheumatoid arthritis), including asthma More adult women have asthma than men Pregnancy, menopause, menstruation all impact asthma Males and females have “different” types of asthma

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Giving hormones to mice worsens asthma like symptoms Hormone supplements influence asthma Girls are more specifically allergic Girls more susceptible to obesity which may also impact asthma Earlier age of menarche associated with asthma severity and obesity

Varasso AJRCCM 2005

Menarche and asthma .

Adolescence associated with increase in asthma in girls Early menarche related to obesity and associated hormone increases Combination of obesity and early menarche associated with the most severe (adult) asthma in women .

Menstrual-Related Asthma.

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Between 30 - 40% of women with asthma experience fluctuations in severity that are associated with their menstrual cycle. previous study indicated that women with menstrual-associated asthma tend to have the following characteristics: Older age Had asthma for a long time Had severe asthma attacks that were likely to occur 3 days before and 4 days into the menstrual period

Two separate studies sugges that hormone levels during “luteal phase”before onset of periods associated with increased risk of asthma Exacerbation.

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Skobeloff Arch Int Med 1996, Martinez-Moragon JACI2004

Birth control pills and asthma

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Theoretically should help asthma sufferers by leveling out hormonal changes, but they do not appear to have much effect. In women without history of asthma, BCPs increased the risk for asthma symptoms by 60% Mechanisms unknown In women WITH a history of asthma, BCPs decreased the likelihood of asthma-related wheezing by over 80% BCPs suppress progesterone surge and may decrease asthma symptoms in this way

Asthma and Pregnancy.

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Many asthma symptoms are known to worsen during pregnancy. The increase in the production of reproductive hormones in women may account for this. During pregnancy, asthma symptoms: improve 1/3 of the time remain the same 1/3 of the time worsen 1/3 of the time.

Menopause and Asthma.

Around the time of menopause (called peri menopause) when estrogen declines, the risk for hospitalization in women with asthma increases fourfold compared to previous years. Studies have not demonstrated that hormone replacement therapy (HRT), which contains estrogen, has much benefit.

Hormone replacement in women&asthma

Hormone replacement therapy (HRT) associated with greater risk for development of asthma in post-menopausal women (and younger women) without a history of asthma HOWEVER, in women WITH asthma, HRT markedly decreased wheezing!!!!..

Female Sex hormones and asthma

Sex hormones and asthma

Epidemiological data indicate that the prevalence and severity of asthma is higher among females than males after puberty. The influence of sex on asthma incidence suggests that sex hormones could play a role in the pathogenesis of asthma in females. However, the mechanisms of the affect of sex are not clear.

(Hayashi et al. 2003)

females are more susceptible to allergic asthma due to TH2 cytokine signals resulting from increased levels of progesterone that naturally occur in the luteal phase of the ovarian cycle. This effect could be further modulated by exogenous progesterone in the form of hormonal birth control or hormone replacement therapy. estradiol modulates the functional activity of bone marrow cells by stimulating the release of IL-4 and inhibiting that of IL-10.

Mast cells are one of the major cells involved in asthma that, have both progesterone and estrogen receptors in lung tissue In addition, it is worth noting that mast cells may represent the primary target responsible for the effects of sex hormones on airways.

Mast cells

Progesterone receptor

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Zhao Thorax 2001

Potential mechanisms

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How and why estrogens and progesterones increase asthma onset in women without asthma HRT may improve asthma in women WITH asthma IN both cases, mechanism not clear Estrogens and progesterones known to have effect on smooth muscle in uterus…what about the lungs? Almost complete absence of studies of hormones on lung tissue

Conclusions on asthma
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less prevalent in girls more prevalent in female adults Multiple studies suggest female hormones play big role in asthma BCPs CAN be tried as therapy for asthma in women with severe disease However, women without asthma might do better without hormonal therapy Studies to explore the mechanisms behind these hormonal effects (and how to deal with them!) are urgently needed.


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