Journal of Asthma and Allergy (Feb 2022)
Sex Disparities in Asthma Development and Clinical Outcomes: Implications for Treatment Strategies
Abstract
Guo-Qiang Zhang,1 Saliha Selin Özuygur Ermis,1,2 Madeleine Rådinger,1 Apostolos Bossios,3,4 Hannu Kankaanranta,1,5,6 Bright Nwaru1,7 1Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 2Department of Respiratory Medicine, Dokuz Eylul University, İzmir, Turkey; 3Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden; 4Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden; 5Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; 6Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland; 7Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, SwedenCorrespondence: Bright Nwaru, Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, P.O. Box 424, Gothenburg, SE-405 30, Sweden, Tel +46 076 064 2614, Email [email protected]: A gender-related disparity exists in asthma morbidity and mortality, which shifts at around puberty from a male predominance to a female predominance. This is clinically reflected in the fact that asthma that occurs in childhood (childhood-onset asthma) mainly affects boys, and that asthma that occurs in adulthood (adult-onset asthma) mainly affects women. Adult-onset asthma is often non-atopic, more severe, and associated with a poorer prognosis, thus posing a marked burden to women’s health and healthcare system. Many factors have been indicated to explain this gender-related disparity, including sociocultural and environmental factors as well as biological sex differences (genetic, pulmonary and immunological factors). It has long been suggested that sex hormones may be implicated in at least these biological sex differences. Overall, the evidence remains equivocal for the role of most sex hormones in asthma pathogenesis and clinical outcomes. Well-designed randomized clinical trials are required assessing the potential preventive or therapeutic effects of hormonal contraceptives on asthma in women, thereby helping to advance the evidence to inform future practice guidelines. The mechanisms underlying the role of sex hormones in asthma are complex, and our understanding is not yet complete. Additional mechanistic studies elucidating sex hormone signaling pathways and their interactions involved in the pathogenesis and clinical manifestations of asthma will help to identify potential sex hormone-driven asthma endotypes and novel therapeutic targets, providing the basis for a more personalized asthma management strategy.Keywords: androgen, asthma, estrogen, progestogen, sex disparity, sex hormone
