Why asthma is different in women

The chronic inflammatory lung disease of asthma affects an estimated 26 million Americans – 19 million adults and 7 million children – and is one of the leading causes of absences from work and school.  Asthma causes inflammation and narrowing of the bronchial tubes, the passageways that allow air to enter and leave the lungs.  This condition, which often runs in families, can leave a person with shortness of breath or where they hear a whistling or wheezy sound in their chest when they breathe.

Asthma worse in women than men

When it comes to differences between the sexes and asthma, women are at a higher risk for asthma in terms of incidence, prevalence, and severity of it.  Women tend to have episodes of progressively worsening shortness of breath, coughing, wheezing, and chest tightness or any combination and are 60 percent more likely than men to be treated in the emergency room requiring hospitalization. 

Up until puberty, boys have higher rates of asthma than girls.  But after puberty, the prevalence and severity in girls of higher odds of persistence of wheezing often becomes worse.  Some women with asthma also have a higher risk of asthma flare-ups during their menstrual cycle.  This can be referred to as premenstrual asthma.  Women who have premenstrual asthma tend to have more severe asthma needing more intense treatment for it.  A study by Norwegian researchers found that respiratory symptoms became more severe around the time of ovulation for women with asthma. 

Even during the menopausal years, the rate of hospitalizations for women double that of men in the same age group, indicating asthma may have distinct biological traits.  Even women who have never been diagnosed with asthma may go through menopause developing it for the first time.  It is believed to be due to the fluctuation of estrogen – especially when estrogen levels drop – that may cause inflammation of the airways.  Estrogen itself is not the cause but rather the alternating ups and downs of hormone levels that appear to trigger it.   

Hormones also appear to play a role of severity of asthma in women. Girls who enter puberty at an early age and women who’ve had more than one child with more exposure to higher estrogen levels and a greater cumulative exposure of sex hormones are at an increased risk for asthma development later on.  What may protect and reduce the exacerbation risk in women with asthma, preventing estrogen and progesterone fluctuation, is using oral contraceptives. 

Another factor recently found associated with asthma is the discovery of innate lymphoid cells (ILC2) which are key players in the pathogenesis of asthma.  Women have more of these ILC2 cells.  Studies have found that in mice, testosterone reduces the number of these cells.  This makes it appear that the hormone estrogen could be what drives asthma and that testosterone may actually reduce or even prevent it. 

How women can keep asthma in check

For women living with chronic asthma, it is best to keep symptoms in check to avoid breathing issues.  Here are some tips that can help keep airways open despite what her hormones may be doing:

·      If a woman has regular periods, she can avoid known allergen substances that may trigger asthma attacks.

·      If a woman has irregular periods, she will need to pay more attention to symptoms. Using a peak flow meter to measure her ability to push air out of her lungs can help. When the numbers begin to decrease, this can indicate her period is approaching, helping her to avoid asthma triggers. 

·      Women should always use her medications prescribed to her for preventing asthma symptoms rather than relying on her rescue inhaler. 

·      Women who are pregnant should also always take their maintenance medications.  Using them is essential for her health and the health of her baby.

·      Women going through menopause, but who have never been diagnosed with asthma, should pay close attention to symptoms indicating asthma such as wheezing and coughing.  If a woman does experience these symptoms, she should talk to her doctor to be tested and treated.