Sex Differences in Severe Asthma: Results From Severe Asthma Network in Italy-SANI

Abstract

Purpose After adolescence, asthma is more frequent in females than in males due to different hormonal, immunologic, and occupational/environmental factors. The higher prevalence and severity of the disease in females have already been reported in international registries. The aim of this study was to explore the difference in terms of clinical, functional, and biological characteristics between male and female patients with severe asthma in a real-life, registry-based setting. Methods Baseline data from the Severe Asthma Network in Italy registry were analyzed in 1,123 patients with severe asthma, according to sex. Results Almost 2/3 of severe asthmatics were female. Late-onset asthma, obesity and gastro-esophageal reflux were more frequent in females than in males, while previous smoking habits and nasal polyposis were more frequent in males. Females had poor asthma control and a higher number of severe exacerbations leading to hospitalization, in comparison to males. Biomarkers of type 2 inflammation (blood eosinophil, exhaled nitric oxide, and serum immunoglobulin E levels) were significantly higher in males than in females. The type 2 profile (defined by a combination of these 3 biomarkers) was significantly more frequent in males than in females. In multivariate analysis, late-onset asthma and a normal body mass index were only independent variables associated with the type 2 profile, while male sex and age showed only a trend toward the association with the type 2 profile. Conclusions Significant differences may be observed between male and female patients with severe asthma, influencing the asthma pheno-endotyping in both sexes.

Sex and gender in asthma

“…Many asthma treatments are targeted towards T2 inflammation (e.g. inhaled and systemic corticosteroids and biologics targeted at IL-4, IL-5 and IL-13), which has been shown to be less common in women compared with men [97,98]. This could contribute to poorer control of asthma in women, regardless of treatment and compliance [99], and a more severe clinical manifestation or perception of asthma [100,101].…”

Just breathe: a review of sex and gender in chronic lung disease

“…The consistent message is that in cohorts of patients with asthma with high disease burden, there is invariably an excess of female patients. A report from the Severe Asthma Network in Italy registry (n=1123) found that two thirds of severe asthma patients were female and reported increased obesity and gastro-oesophageal reflux as well as increased age of onset in females [108]. Females had greater disease burden with more hospitalisations and worse asthma control while males had greater markers of T2 inflammation such as eosinophilia and IgE levels.…”

The Human Microbiome, an Emerging Key-Player in the Sex Gap in Respiratory Diseases

“…Interestingly, during childhood, asthma is more frequent in boys than in girls (16); then the pattern reverses around 16-18 years of age (17). In adulthood, in addition to a higher prevalence, asthma is more severe in women, who tend to have higher healthcare use, poor asthma control, and a higher number of severe exacerbations leading to hospitalization than men (18)(19)(20). In adulthood, a sex-based difference is also observed in COPD with regard to clinicoradiographic phenotype, symptom severity, and quality of life.…”