Sex differences in asthma symptom profiles and control in the American Lung Association Asthma Clinical Research Centers

Abstract

Objective Important differences between men and women with asthma have been demonstrated, with women describing more symptoms and worse asthma-related quality of life (QOL) despite having similar or better pulmonary function. While current guidelines focus heavily on assessing asthma control, they lack information about whether sex-specific approaches to asthma assessment should be considered. We sought to determine if sex differences in asthma control or symptom profiles exist in the well-characterized population of participants in the American Lung Association Asthma Clinical Research Centers (ALA-ACRC) trials. Methods We reviewed baseline data from four trials published by the ALA-ACRC to evaluate individual item responses to three standardized asthma questionnaires: the Juniper Asthma Control Questionnaire (ACQ), the multi-attribute Asthma Symptom Utility Index (ASUI), and Juniper Mini Asthma Quality of Life Questionnaire (mini-AQLQ). Results In the poorly-controlled population, women reported similar overall asthma control (mean ACQ 1.9 vs. 1.8; p=0.54), but were more likely to report specific symptoms such as nocturnal awakenings, activity limitations, and shortness of breath on individual item responses. Women reported worse asthma-related QOL on the mini-AQLQ (mean 4.5 vs. 4.9; p<0.001) and more asthma-related symptoms with a lower mean score on the ASUI (0.73 vs. 0.77; p=<0.0001) and were more likely to report feeling bothered by particular symptoms such as coughing, or environmental triggers. Conclusions In participants with poorly-controlled asthma, women had outwardly similar asthma control, but had unique symptom profiles on detailed item analyses which were evident on evaluation of three standardized asthma questionnaires.

Boswellic acid attenuates asthma phenotype by downregulation of GATA3 via nhibition of PSTAT6

“…In addition, pSTAT6 expression also appears to increase in the pathogenesis of asthma. All of these indicate that pSTAT6 and GATA3 have different pathological functions (Mandal et al, 2010;Poritz et al, 2010;McCallister et al, 2013).…”

Post-menopausal Women Exhibit Greater Interleukin-6 Responses to Mental Stress Than Older Men

“…This finding may therefore have important clinical implications. Several inflammatoryrelated conditions including rheumatoid arthritis and asthma [32,33] are more prevalent in women, and stress has been identified as a trigger of symptom exacerbation. For example, emotional stress seems to exacerbate asthma symptoms through up-regulating HPA axis feedback loop leading to greater cytokine release [34,35].…”

Significant predictors of poor quality of life in older asthmatics

“…This is consistent with findings from studies in younger age groups showing that female asthmatics have poorer asthma-related quality of life. 20 Women make more visits to providers, receive more tests, and are prescribed more medications than men. 37,38 It has also been suggested that men may underreport their symptoms compared to women.…”

“…17 Despite speculation that asthma-related quality of life is lower in older asthmatics, studies involving the mAQLQ have included small numbers of asthmatics over age 65 years. 18-20 In addition, few studies have administered the mAQLQ to stable, older asthmatics in an outpatient setting. Identifying factors that predict poor total mAQLQ scores and specific domain scores may lead to interventions that will significantly improve quality of life in this growing demographic.…”