Elsevier

Clinics in Chest Medicine

Volume 42, Issue 3, September 2021, Pages 497-506
Clinics in Chest Medicine

Unique Aspects of Asthma in Women

https://doi.org/10.1016/j.ccm.2021.04.009Get rights and content

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Key points

  • •
    Asthma is more common in women and expresses unique aspects compared with men.
  • •
    Asthma affects fertility and therapy with female sex hormones affect asthma.
  • •
    Pregnant women with asthma should be managed by an asthma specialist.

Epidemiology

It is estimated that 4.3% (>300 million people) of the worlds’ population has asthma and the overall prevalence of asthma is around 20% higher in women than in men.1,3,14 In the younger ages (<15 years), boys have a higher incidence of allergy, asthma, and asthma-related hospitalizations and exacerbations than girls.6,15 However, around puberty there is a shift and new-onset asthma becomes more common among girls.4 Severe asthma and nonallergic asthma are especially frequent among younger and

Diagnosis

The Global Initiative for Asthma14 recommends that asthma be diagnosed based on a medical history with 1 or more characteristic symptoms (Box 1) and a positive asthma test documenting airflow variability or airway hyperresponsiveness.17 Generally, symptoms present as a group, are often worse at night or in the morning, and are often triggered by exercise, laughter, cold air, and viral infections. Evidence of airflow variability can easily be performed in general practice, but this test cannot

Common differential diagnoses in women

When failing to establish a diagnosis of asthma or the effect of treatment is insufficient, it is important to consider asthma with concomitant diseases or other diagnoses mimicking asthma.

Type 2-Mediated Asthma

In type 2-mediated asthma, inflammation is facilitated by several cell types, including eosinophils, mast cells, macrophages, T lymphocytes, and epithelial cells.24 Asthma can present as allergic or nonallergic, where the nonallergic eosinophilic endotype is mediated through type 2 innate lymphoid cells. Androgens have been shown to decrease type 2 innate lymphoid signaling and could be one of the drivers of the sex difference in asthma and explain the shift in incidence around puberty.25

Adolescents and Young Adults

As stated elsewhere in this article, asthma in childhood is found mainly in boys. However, around the time of menarche there is a shift toward a female predominance. Asthma in the premenstrual phase is often severe and these patients are more likely to be obese and to have aspirin-induced symptoms. Further, their transition into physical adulthood is often impacted by more severe symptoms of dysmenorrhea, short menstrual cycles, and mood changes compared with girls without premenstrual asthma.14

Infertility

Although still quite novel, evidence is emerging to support that asthma affects fertility in women. It has recently been shown that women with asthma have prolonged time to pregnancy and a tendency toward a greater number of pregnancy losses owing to spontaneous abortions.70, 71, 72 Further, a study including women with asthma who recently had given birth to a full-term child and a control cohort, found that asthma was associated with longer time to pregnancy.73 Another study showed an

Summary

All stages of a woman’s life affect asthma in different ways. Additionally, because it is becoming clear that asthma affects fertility and female sex hormones in various forms affect asthma, further mechanistic and epidemiologic research into this field is highly warranted. Last, because pregnant women are at high risk of adverse outcomes of asthma and pregnancy, they should be followed by an asthma specialist.

Clinics care points

  • •
    Different stages of a woman’s lifeexpress unique aspects of asthma.
  • •
    Asthma affects the fertility.
  • •
    Hormone therapy affects asthma.
  • •
    The course of asthma during pregnancy is unpredictable.

Conflicts of interest

Dr ESH Hansen has no relevant conflicts of interest to declare. Dr C. Tidemandsen has no relevant conflicts of interest to declare. Dr SM Rasmussen has no relevant conflicts of interest to declare. Professor V. Backer has received an unrestricted grant for an asthma and fertility study by Novartis, has been part of advisory boards concerning asthma therapy by GSK, Teva, Chiesi, MSD, Novartis, AZ. Professor CS Ulrik has received personal fees for lectures, advisory board meetings, and so one,

Acknowledgments

The Center for Physical Activity Research (CFAS) is supported by TrygFonden (grants ID 101390 and ID 20045).

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References (88)

  • Z. Ali et al.

    Low risk of adverse obstetrical and perinatal outcome in pregnancies complicated by asthma: a case control study

    Respir Med

    (2016)
  • R. Enriquez et al.

    Effect of maternal asthma and asthma control on pregnancy and perinatal outcomes

    J Allergy Clin Immunol

    (2007)

  • The global asthma report 2018

    (2018)

  • “Asthma, fact sheet, WHO,” asthma fact sheet

    (2017)
  • S. Lieberoth et al.

    Age at menarche and risk of asthma: systematic review and meta-analysis

    J Asthma

    (2014)
  • B. Leynaert et al.

    Gender differences in prevalence, diagnosis and incidence of allergic and non-allergic asthma: a population-based cohort

    Thorax

    (2012)
  • S.F. Thomsen et al.

    Association between obesity and asthma in a twin cohort

    Allergy Eur J Allergy Clin Immunol

    (2007)
  • B.I. Nwaru et al.

    Hormonal contraceptives and asthma in women of reproductive age: analysis of data from serial National Scottish Health Surveys

    J R Soc Med

    (2015)
  • P. Lange et al.

    Exogenous female sex steroid hormones and risk of asthma and asthma-like symptoms: a cross sectional study of the general population

    Thorax

    (2001)
  • M.C. Matheson et al.

    Hormonal contraception increases risk of asthma among obese but decreases it among nonobese subjects: a prospective, population-based cohort study

    ERJ Open Res

    (2015)
  • F. Macsali et al.

    Respiratory health in women: from menarche to menopause

    Expert Rev Respir Med

    (2012)
  • P.A. Loftus et al.

    Epidemiology and economic burden of asthma

    Int Forum Allergy Rhinol

    (2015)

  • 2019 GINA report: global strategy for asthma management and prevention 2019

    (2018)
  • G.H. Blanche Dawson et al.

    Survey of childhood asthma in Aberdeen

    Paediatr Res Soc

    (1962)
  • A. Gillman et al.

    Asthma in the elderly

    Asia Pac Allergy

    (2012)
  • B.L. Graham et al.

    Standardization of spirometry 2019 update an official American Thoracic Society and European Respiratory Society technical statement

    Am J Respir Crit Care Med

    (2019)
  • T.S. Hallstrand et al.

    ERS technical standard on bronchial challenge testing: pathophysiology and methodology of indirect airway challenge testing

    Eur Respir J

    (2018)
  • A.L. Coates et al.

    ERS technical standard on bronchial challenge testing: general considerations and performance of methacholine challenge tests

    Eur Respir J

    (2017)
  • R. Courtney

    Breathing training for dysfunctional breathing in asthma: taking a multidimensional approach

    ERJ Open Res

    (2017)
  • A. Mathur et al.

    The management of chronic cough

    QJM

    (2019)
  • T.S. Ingebrigtsen et al.

    Coronary heart disease and heart failure in asthma, COPD and asthma-COPD overlap

    BMJ Open Respir Res

    (2020)
  • C.J. Oliphant et al.

    Insights into the initiation of type 2 immune responses

    Immunology

    (2011)
  • S. Laffont et al.

    Androgen signaling negatively controls group 2 innate lymphoid cells

    J Exp Med

    (2017)
  • P. Flood-Page et al.

    A study to evaluate safety and efficacy of mepolizumab in patients with moderate persistent asthma

    Am J Respir Crit Care Med

    (2007)
  • T.F. Carr et al.

    Eosinophilic and noneosinophilic asthma

    Am J Respir Crit Care Med

    (2018)
  • G.A. Westerhof et al.

    Biomarkers to identify sputum eosinophilia in different adult asthma phenotypes

    Eur Respir J

    (2015)
  • C. Kroegel et al.

    Asthmatic airway inflammation

    Zeitschrift für ärztliche Fortbildung

    (2001)
  • K. Pałgan et al.

    Remodeling of the basement membrane and airway epithelium in patients with asthma

    Pol Merkur Lek

    (2005)
  • H. Park et al.

    A distinct lineage of CD4 T cells regulates tissue inflammation by producing interleukin 17

    Nat Immunol

    (2005)
  • L.E. Harrington et al.

    Interleukin 17-producing CD4+ effector T cells develop via a lineage distinct from the T helper type 1 and 2 lineages

    Nat Immunol

    (2005)
  • N.R. Bhakta et al.

    Human asthma phenotypes: from the clinic, to cytokines, and back again

    Immunol Rev

    (2011)

  • Trends in asthma morbidity and mortality

    Am Lung Assoc Epidemiol Stat

    (2012)
  • H. Fuseini et al.

    Mechanisms driving Gender differences in asthma

    Curr Allergy Asthma Rep

    (2017)
  • F.M. de Benedictis et al.

    Asthma in childhood

    Eur Respir Rev

    (2016)
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