Asthma Across a Woman’s Lifespan

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Navitha Ramesh, MD, FCCP

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References

1. Chowdhury NU et al. Eur Respir Rev. 2021;30(162):210067. doi:10.1183/16000617.0067-2021

2. Perikleous EP et al. J Pers Med. 2022;12(6):999. doi:10.3390/jpm12060999

3. Khaleva E et al. Clin Transl Allergy. 2020;10:40. doi:10.1186/s13601-020-00340-z

4. Robijn AL et al. Curr Opin Pulm Med. 2019;25(1):11-17. doi:10.1097/MCP.0000000000000538

5. Bravo-Solarte DC et al. Allergy Asthma Proc. 2023;44(1):24-34. doi:10.2500/aap.2023.44.220077

6. Wang G et al. J Matern Fetal Neonatal Med. 2014;27(9):934-942. doi:10.3109/14767058.2013.847080

7. Hough KP et al. Front Med (Lausanne). 2020;7:191. doi:10.3389/fmed.2020.00191

8. Triebner K et al. Am J Respir Crit Care Med. 2017;195(8):1058-1065. doi:10.1164/rccm.201605-0968OC

9. Bacharier LB, Jackson DJ. J Allergy Clin Immunol. 2023;151(3):581-589. doi:10.1016/j.jaci.2023.01.002

10. An amazing journey: how young lungs develop. American Lung Association. Published May 11, 2018. Accessed June 28, 2023. https://www.lung.org/blog/how-young-lungs-develop

11. Strunk RC et al. J Allergy Clin Immunol. 2006;118(5):1040-1047. doi:10.1016/j.jaci.2006.07.053

12. Kaplan A, Price D. J Asthma Allergy. 2020;13:39-49. doi:10.2147/JAA.S233268

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CHEST Physician
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Asthma
Author(s)
Navitha Ramesh, MD, FCCP
Author(s)
Navitha Ramesh, MD, FCCP

Click to view more from Pulmonology Data Trends 2023.

Click to view more from Pulmonology Data Trends 2023.

References

1. Chowdhury NU et al. Eur Respir Rev. 2021;30(162):210067. doi:10.1183/16000617.0067-2021

2. Perikleous EP et al. J Pers Med. 2022;12(6):999. doi:10.3390/jpm12060999

3. Khaleva E et al. Clin Transl Allergy. 2020;10:40. doi:10.1186/s13601-020-00340-z

4. Robijn AL et al. Curr Opin Pulm Med. 2019;25(1):11-17. doi:10.1097/MCP.0000000000000538

5. Bravo-Solarte DC et al. Allergy Asthma Proc. 2023;44(1):24-34. doi:10.2500/aap.2023.44.220077

6. Wang G et al. J Matern Fetal Neonatal Med. 2014;27(9):934-942. doi:10.3109/14767058.2013.847080

7. Hough KP et al. Front Med (Lausanne). 2020;7:191. doi:10.3389/fmed.2020.00191

8. Triebner K et al. Am J Respir Crit Care Med. 2017;195(8):1058-1065. doi:10.1164/rccm.201605-0968OC

9. Bacharier LB, Jackson DJ. J Allergy Clin Immunol. 2023;151(3):581-589. doi:10.1016/j.jaci.2023.01.002

10. An amazing journey: how young lungs develop. American Lung Association. Published May 11, 2018. Accessed June 28, 2023. https://www.lung.org/blog/how-young-lungs-develop

11. Strunk RC et al. J Allergy Clin Immunol. 2006;118(5):1040-1047. doi:10.1016/j.jaci.2006.07.053

12. Kaplan A, Price D. J Asthma Allergy. 2020;13:39-49. doi:10.2147/JAA.S233268

References

1. Chowdhury NU et al. Eur Respir Rev. 2021;30(162):210067. doi:10.1183/16000617.0067-2021

2. Perikleous EP et al. J Pers Med. 2022;12(6):999. doi:10.3390/jpm12060999

3. Khaleva E et al. Clin Transl Allergy. 2020;10:40. doi:10.1186/s13601-020-00340-z

4. Robijn AL et al. Curr Opin Pulm Med. 2019;25(1):11-17. doi:10.1097/MCP.0000000000000538

5. Bravo-Solarte DC et al. Allergy Asthma Proc. 2023;44(1):24-34. doi:10.2500/aap.2023.44.220077

6. Wang G et al. J Matern Fetal Neonatal Med. 2014;27(9):934-942. doi:10.3109/14767058.2013.847080

7. Hough KP et al. Front Med (Lausanne). 2020;7:191. doi:10.3389/fmed.2020.00191

8. Triebner K et al. Am J Respir Crit Care Med. 2017;195(8):1058-1065. doi:10.1164/rccm.201605-0968OC

9. Bacharier LB, Jackson DJ. J Allergy Clin Immunol. 2023;151(3):581-589. doi:10.1016/j.jaci.2023.01.002

10. An amazing journey: how young lungs develop. American Lung Association. Published May 11, 2018. Accessed June 28, 2023. https://www.lung.org/blog/how-young-lungs-develop

11. Strunk RC et al. J Allergy Clin Immunol. 2006;118(5):1040-1047. doi:10.1016/j.jaci.2006.07.053

12. Kaplan A, Price D. J Asthma Allergy. 2020;13:39-49. doi:10.2147/JAA.S233268

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The severity and symptoms of asthma vary greatly across a woman’s lifespan. Gender-based variances start early, with boys having a higher asthma prevalence than girls in childhood, and women having a higher prevalence than men starting around puberty and through adulthood, related to changes in sex hormones.1 In the pediatric age group, questions arise about both the necessity and choice of biologic therapies and how best to transition patients from pediatric to adult care.2,3 During this transition, patients often have worsening symptoms mainly due to decreased adherence to medications, lack of insurance, or lack of parental and social support.3

In adulthood, around 13% of women have asthma symptoms during pregnancy, necessitating maintenance treatment with inhalers.4 In some women, asthma symptoms tend to worsen during pregnancy due to some of the natural changes in lung function and breathing patterns during pregnancy.4,5 Uncontrolled asthma in pregnancy can lead to adverse effects for both mother and fetus. Maternal adverse outcomes include preeclampsia, placental abruption, increased risk of Caesarean sections, increased risk of gestational diabetes mellitus, and pulmonary embolism.4-6 Child adverse outcomes include low birth weight, increased risk of minor congenital malformations, and asthma.4,5 Aging in women also affects lung function, including reducing the forced expiratory volume in 1 second (FEV1).7 Menopause specifically is related todecreased lung function due to changes in sex hormones, and this effect is seen even more in women with asthma.7,8 It is important for providers to be aware of asthma manifestations throughout a woman’s lifespan and personalize care accordingly.

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Comorbidities, Racial Disparities, and Geographic Differences in Asthma

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References
  1. Wenzel M. Gasping for a diagnosis: pediatric vocal cord dysfunction. J Pediatr Health Care. 2019;33(1):5-13. doi:10.1016/j.pedhc.2018.03.002
  2. Mogensen I, James A, Malinovschi A. Systemic and breath biomarkers for asthma: an update. Curr Opin Allergy Clin Immunol. 2020;20(1):71-79. doi:10.1097/ACI.0000000000000599
  3. Gibson PG, McDonald VM, Granchelli A, Olin JT. Asthma and comorbid conditions—pulmonary comorbidity. J Allergy Clin Immunol Pract. 2021;9(11):3868-3875. doi:10.1016/j. jaip.2021.08.028
  4. Peters U, Dixon AE, Forno E. Obesity and asthma. J Allergy Clin Immunol. 2018;141(4):1169-1179. doi:10.1016/j.jaci.2018.02.004
  5. Adult obesity facts. Centers for Disease Control and Prevention. Published May 17, 2022. Accessed June 7, 2022. https://www.cdc.gov/obesity/data/adult.html
  6. Sharma V, Cowan DC. Obesity, inflammation, and severe asthma: an update. Curr Allergy Asthma Rep. 2021;21(12):46. doi:10.1007/s11882-021-01024-9
  7. Assari S, Chalian H, Bazargan M. Race, ethnicity, socioeconomic status, and chronic lung disease in the U.S. Res Health Sci. 2020;5(1):48-63. doi:10.22158/rhs.v5n1p48
  8. Bleecker ER, Gandhi H, Gilbert I, Murphy KR, Chupp GL. Mapping geographic variability of severe uncontrolled asthma in the United States: management implications. Ann Allergy Asthma Immunol. 2022;128(1):78-88. doi:10.1016/j.anai.2021.09.025
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Author(s)
Navitha Ramesh, MD, FCCP
Author(s)
Navitha Ramesh, MD, FCCP

Click to view more from Pulmonology Data Trends 2022.

 

Click to view more from Pulmonology Data Trends 2022.

 

References
  1. Wenzel M. Gasping for a diagnosis: pediatric vocal cord dysfunction. J Pediatr Health Care. 2019;33(1):5-13. doi:10.1016/j.pedhc.2018.03.002
  2. Mogensen I, James A, Malinovschi A. Systemic and breath biomarkers for asthma: an update. Curr Opin Allergy Clin Immunol. 2020;20(1):71-79. doi:10.1097/ACI.0000000000000599
  3. Gibson PG, McDonald VM, Granchelli A, Olin JT. Asthma and comorbid conditions—pulmonary comorbidity. J Allergy Clin Immunol Pract. 2021;9(11):3868-3875. doi:10.1016/j. jaip.2021.08.028
  4. Peters U, Dixon AE, Forno E. Obesity and asthma. J Allergy Clin Immunol. 2018;141(4):1169-1179. doi:10.1016/j.jaci.2018.02.004
  5. Adult obesity facts. Centers for Disease Control and Prevention. Published May 17, 2022. Accessed June 7, 2022. https://www.cdc.gov/obesity/data/adult.html
  6. Sharma V, Cowan DC. Obesity, inflammation, and severe asthma: an update. Curr Allergy Asthma Rep. 2021;21(12):46. doi:10.1007/s11882-021-01024-9
  7. Assari S, Chalian H, Bazargan M. Race, ethnicity, socioeconomic status, and chronic lung disease in the U.S. Res Health Sci. 2020;5(1):48-63. doi:10.22158/rhs.v5n1p48
  8. Bleecker ER, Gandhi H, Gilbert I, Murphy KR, Chupp GL. Mapping geographic variability of severe uncontrolled asthma in the United States: management implications. Ann Allergy Asthma Immunol. 2022;128(1):78-88. doi:10.1016/j.anai.2021.09.025
References
  1. Wenzel M. Gasping for a diagnosis: pediatric vocal cord dysfunction. J Pediatr Health Care. 2019;33(1):5-13. doi:10.1016/j.pedhc.2018.03.002
  2. Mogensen I, James A, Malinovschi A. Systemic and breath biomarkers for asthma: an update. Curr Opin Allergy Clin Immunol. 2020;20(1):71-79. doi:10.1097/ACI.0000000000000599
  3. Gibson PG, McDonald VM, Granchelli A, Olin JT. Asthma and comorbid conditions—pulmonary comorbidity. J Allergy Clin Immunol Pract. 2021;9(11):3868-3875. doi:10.1016/j. jaip.2021.08.028
  4. Peters U, Dixon AE, Forno E. Obesity and asthma. J Allergy Clin Immunol. 2018;141(4):1169-1179. doi:10.1016/j.jaci.2018.02.004
  5. Adult obesity facts. Centers for Disease Control and Prevention. Published May 17, 2022. Accessed June 7, 2022. https://www.cdc.gov/obesity/data/adult.html
  6. Sharma V, Cowan DC. Obesity, inflammation, and severe asthma: an update. Curr Allergy Asthma Rep. 2021;21(12):46. doi:10.1007/s11882-021-01024-9
  7. Assari S, Chalian H, Bazargan M. Race, ethnicity, socioeconomic status, and chronic lung disease in the U.S. Res Health Sci. 2020;5(1):48-63. doi:10.22158/rhs.v5n1p48
  8. Bleecker ER, Gandhi H, Gilbert I, Murphy KR, Chupp GL. Mapping geographic variability of severe uncontrolled asthma in the United States: management implications. Ann Allergy Asthma Immunol. 2022;128(1):78-88. doi:10.1016/j.anai.2021.09.025
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Asthma management is becoming increasingly personalized, making it crucial to evaluate the various comorbidities and socioeconomic factors affecting patient care. Asthma is no longer simply understood as the typical allergic asthma requiring treatment with corticosteroids. There is an evolving distinction between allergen-specific T helper 2 (Th2) and non-Th2 asthma.1 In Th2 asthma, eosinophilic inflammation plays a key role, whereas in non-Th2 asthma, neutrophils are the primary inflammatory cells involved.1 Asthma masqueraders, such as vocal cord dysfunction, chronic obstructive pulmonary disease, eosinophilic granulomatosis with polyangiitis, etc, must be considered in the differential diagnosis, and asthma comorbidities, such as upper airway cough syndrome, gastroesophageal reflux, depression, and anxiety, have to be actively sought out and managed appropriately.2

Racial, socioeconomic, and geographic characteristics are also key patient factors that affect asthma symptoms and control, quality of life, and asthma-related morbidity and mortality. Assessing and understanding the multiple factors that affect each patient is crucial in the optimal management of asthma symptoms, and also preventing exacerbations, which in turn lead to accelerated loss of lung function.

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