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Dr.Fawzia abo aliProf. of int. medicine & clinical immunology

Faculty of medicine

Ain shams university

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Asthma is a chronic inflammatoryairway 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 straightforwardmechanism can explain the gender

differences found in asthma.

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Asthma & Gender

Before puberty, asthma occurs more oftenin males, but after adolescence, it appears

to be more common in females.

At adolescence, girls have greater

likelihood of new onset asthma, while manyboys grow out of asthma

In adults with similar cases of actual

airway obstruction, women are likely to

report more severe symptoms than men

are.

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Age and asthma - male : female ratio

Age frequent

episodic

7 2.1

12 2.1

21 1.5

28 1.3

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Women and asthma

Many diseases more common/severe inwomen (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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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 .

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Menstrual-Related Asthma.

Between 30 - 40% of women with asthmaexperience 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

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Two separate studies sugges that hormonelevels during luteal phasebefore onset of

periods associated with increased risk of

asthma Exacerbation.

Skobeloff Arch Int Med 1996,

Martinez-Moragon JACI2004

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Birth control pills andasthma 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, BCPsincreased the risk for asthma symptoms by 60%

Mechanisms unknown In women WITH a history of asthma, BCPs

decreased the likelihood of asthma-relatedwheezing by over 80%

BCPs suppress progesterone surge and may

decrease asthma symptoms in this way

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Asthma and Pregnancy.

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.

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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.

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Hormone replacement inwomen&asthma

Hormone replacement therapy (HRT)

associated with greater risk for development

of asthma in post-menopausal women (and

younger women) without a history ofasthma

HOWEVER, in women WITH asthma, HRT

markedly decreased wheezing!!!!..

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Female Sex hormones and

asthma

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Sex hormones and

asthma Epidemiological data indicate that theprevalence and severity of asthma is higher

among females than males after puberty.

The influence of sex on asthma incidencesuggests that sex hormones could play a role

in the pathogenesis of asthma in females.

However, the mechanisms of the affect of sexare not clear.

(Hayashi et al. 2003)

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females are more susceptible to allergic asthma

due to TH2 cytokine signals resulting fromincreased 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 ofhormonal birth control or hormone replacement

therapy.

estradiol modulates the functional activity

ofbone marrow cells by stimulating the release of

IL-4 andinhibiting that of IL-10.

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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 thatmast cells may

represent the primary target responsible for

the effects of sex hormones on airways.

Mast cellsProgesteronereceptor

Zhao

Thorax 2001

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Potential mechanisms How and why estrogens and progesterones

increase asthma onset in women withoutasthma

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 uteruswhat about

the lungs? Almost complete absence of studies of

hormones on lung tissue

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Conclusions on asthma

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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THANK YOUTHANK YOU