How Severe Asthma Differs for Women

M.A., Health Writer
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Men and women often see things differently, and sometimes they experience illnesses differently, too. We know that 25 million people in the United States have asthma. Scientific studies show that differences exist between the two genders in terms of incidence, prevalence, and severity of asthma. This slideshow looks at how asthma in women may be different from asthma in men.


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Major differences exist

According to a 2016 review, "Asthma is Different in Women," in Current Allergy and Asthma Reports, major differences really do exist. In fact, asthma prevalence, severity and exacerbation rate — episodes of progressively worsening shortness of breath, coughing, wheezing, and chest tightness or any combination of those — hospitalizations, and mortality are higher among women than men overall.


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Obesity, particulates, and smoking

Asthma in early childhood is associated with obesity in young girls, according to four studies cited in that review. In a 2011 study, exposure to particulate matter or second-hand-smoking were associated with lower forced expiratory volume — exhaling during a forced breath — in women less than 55 years old, but not in men. Another 2011 study, done in China, found girls with allergic tendencies reported respiratory symptoms from air pollution more frequently than boys.


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The menstrual connection

The transition to adult from childhood means higher odds of persistence of wheezing in females. It also means worsening of asthma for them, the review notes. According to an American Journal of Respiratory and Critical Care Medicine report, some women diagnosed with asthma do have exacerbations linked to their menstrual cycle. However, no one is sure "when" in the cycle women are at highest risk for those exacerbations.


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The gender switch

After puberty, asthma becomes more prevalent and severe in females, says the 2016 review. One study finds asthma prevalence increases in women after 11.1 years through 16.3 years. Women who have premenstrual asthma are at higher risk for severe asthma and for the more intense treatments required for it. Another study finds that in women who have premenstrual asthma — right before and during the first part of their period — asthma risk is doubled in girls with an early first menstrual period.


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The role of hormones

Asthma prevalence in women who've had more than one child increases along with the number of births they've experienced, the review authors say. Early-maturing girls and pregnant women exposed to higher estrogen levels and greater cumulative exposure of sex hormones are at increased risk for asthma development later. Oral contraceptive use may protect and lower exacerbation risk in women with asthma, says the journal report, preventing estrogen and progesterone fluctuation.


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A big idea

"Women have more ILC2 cells, which are associated with asthma, than do men," says Mitchell H. Grayson, M.D., chief of the Division of Allergy and Immunology for Nationwide Children's Hospital and professor of pediatrics at The Ohio State University. "In mice it turns out that testosterone reduces the number of these ILC2 cells. Research suggests that not only could estrogen drive asthma, but testosterone could actually prevent asthma or at least reduce it."


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When symptoms get serious

Up to 40 percent of women of reproductive age who also have asthma have said their asthma symptoms get worse when they're premenstrual or having a period. Studies showed that some women had only minor problems, but others' menstrual-related changes in asthma symptoms meant higher utilization of healthcare resources and near-fatal asthma episodes.


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The meaning of menopause

A 2015 PLOS One study suggests that after age 45, severe asthma increases in men, but not in women. Asthma severity drops between ages 50 to 65 in menopausal women compared to men, which lends credence to the theory that menopause is a friend to asthma.


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Effects of hormone replacement therapy

Relative risk of new onset is not affected by menopause but use of postmenopausal hormone therapy (HT) has implications. Post-menopausal women on HT had an increased risk of asthma, compared to premenopausal women. In women with pre-existing asthma, HT was shown to improve respiratory symptoms and decrease exacerbations.


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How women view their asthma

Female asthma, overall, is more severe and requires more healthcare dollars for treatment. In general, women are known to be more proactive in their health. Studies suggest women view their health differently and are more proactive when it comes to tending to symptoms of asthma.


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Challenges reported by women

Several studies suggest that women report worse asthma-related quality of life, higher perception of dyspnea or shortness of breath, more depression, more use of rescue inhalers, and more physical limitations than men. In a 2010 study, women reported more anxiety, more daytime sleepiness, and insomnia.


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Asthma, inhalers, and fertility

Women diagnosed with asthma who regularly use short-acting inhalers may have a higher incidence of developing infertility. The study did also show that regular use of longer-acting inhalers did not appear to impact fertility. Short-acting asthma treatments may improve symptoms, but inflammation in the lungs and other parts of the body, including the uterus may persist.