Dr.

Fawzia abo ali

Prof. of int. medicine & clinical immunology
Faculty of medicine
Ain shams university
 Asthma is a chronic inflammatory
airway 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 straightforward
mechanism can explain the gender
differences found in asthma.
Asthma & Gender
 Before puberty, asthma occurs more often
in males, but after adolescence, it appears
to be more common in females.
 At adolescence, girls have greater
likelihood of new onset asthma, while many
boys “grow out” of asthma
 In adults with similar cases of actual
airway obstruction, women are likely to
report more severe symptoms than men
are.
Age and asthma - male : female ratio
Age frequent
episodic
7 2.1
12 2.1

21 1.5
28 1.3
Women and asthma
 Many diseases more common/severe in
women (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
 Giving hormones to mice worsens asthma like
symptoms
 Hormone supplements influence asthma
 Girls are more specifically allergic
 Girls more susceptible to obesity which may
also impact asthma
 Earlier age of menarche associated with asthma
severity and obesity

Varasso AJRCCM 2005

 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 .
Menstrual-Related Asthma.
 Between 30 - 40% of women with asthma
experience 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
 Two separate studies sugges that hormone
levels during “luteal phase”before onset of
periods associated with increased risk of
asthma Exacerbation.

 Skobeloff Arch Int Med 1996,

 Martinez-Moragon JACI2004
Birth control pills and
asthma
 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, BCPs
increased the risk for asthma symptoms by 60%
 Mechanisms unknown
 In women WITH a history of asthma, BCPs
decreased the likelihood of asthma-related
wheezing by over 80%
 BCPs suppress progesterone surge and may
decrease asthma symptoms in this way
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.
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.
Hormone replacement in
women&asthma

 Hormone replacement therapy (HRT)

associated with greater risk for development
of asthma in post-menopausal women (and
younger women) without a history of
asthma
 HOWEVER, in women WITH asthma, HRT
markedly decreased wheezing!!!!..
Female Sex hormones and
asthma
Sex hormones and
asthma
 Epidemiological data indicate that the
prevalence and severity of asthma is higher
among females than males after puberty.
 The influence of sex on asthma incidence
suggests that sex hormones could play a role
in the pathogenesis of asthma in females.
 However, the mechanisms of the affect of sex
are not clear.
(Hayashi et al. 2003)
 females are more susceptible to allergic asthma
due to TH2 cytokine signals resulting from
increased 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 of
hormonal birth control or hormone replacement
therapy.
 estradiol modulates the functional activity of
bone marrow cells by stimulating the release of
IL-4 and inhibiting that of IL-10.
  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 that mast cells may
represent the primary target responsible for
the effects of sex hormones on airways.

Mast cells
Progesterone
receptor

 Zhao
 Thorax 2001
Potential mechanisms
 How and why estrogens and progesterones
increase asthma onset in women without
asthma
 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 uterus…what about
the lungs?
 Almost complete absence of studies of
hormones on lung tissue
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.
THANK YOU