Sex-Based Differences in Bronchial Asthma: What Are the Mechanisms behind Them?

Abstract

Sex-based differences in bronchial asthma can already be observed in childhood, at which time allergic atopic asthma is more frequently found in boys than in girls. In adulthood, higher prevalence of asthma is reported in women, especially for the more severe neutrophilic subtype associated with obesity, which responds poorly to corticosteroids. Sex-based differences seem to be attributable to changing levels of estrogens, progesterone, and testosterone, which may exert mainly pro-inflammatory (estrogens, progesterone) or anti-inflammatory effects (testosterone). Sex steroids differentially influence lung immune responses, airway reactivity, and pulmonary circulation and may thereby contribute to the higher susceptibility of females to more serious complications resulting from inflammatory lung diseases compared to males. However, other factors, such as anatomical and physiological differences in the lungs, differences in genetically conditioned factors, obesity and lifestyle, smoking, exposure to environmental and occupational factors, chronic stress, etc., may also contribute to the sex-based differences in asthma. Elucidation of the mechanisms behind these differences may contribute to more appropriate personalized therapy for asthma. For the review, articles in the English language from the PubMed database were used.

Keywords

• bronchial asthma
• asthma endotypes
• asthma phenotypes
• sex hormones
• sex-based differences
• obesity