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Mechanisms Driving Gender Differences in Asthma

  • Basic and Applied Science (I Lewkowich, Section Editor)
  • Published:
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Abstract

Purpose of Review

Many phenotypes of asthma exist, ranging from mild asthma with onset during childhood to severe asthma with later onset, making asthma a broad disease with different pathologies. A gender disparity exists in asthma prevalence. As adults, women have an increased asthma prevalence compared to men. Further, women are more likely to have severe asthma and a later onset of asthma compared to men. Here, we review clinical and animal studies that have defined the role of sex hormones in airway inflammation, smooth muscle contraction, mucus production, and airway mechanics associated with asthma pathogenesis.

Recent Findings

Clinical evidence shows that increased asthma symptoms occur in females starting at puberty compared to those in boys. However, after puberty, the role for sex hormones in regulating asthma symptoms during menstruation, pregnancy, and menopause is not as clear. Animal studies have shown that estrogen increases and testosterone decreases Th2-mediated airway inflammation, and that females have increased IL-17A-mediated airway inflammation compared to males. Further, females had increased DC and Mϕ function compared to males. However, the mechanisms driving the types of allergic inflammation are not fully elucidated.

Summary

Overall, ovarian hormones increased and testosterone decreased airway inflammation in asthma, but the mechanisms remain unclear. Delineating these pathways using animal models as well as women and men with various phenotypes of asthma will help determine if women with asthma should take (or avoid) hormonal contraceptives as well as predict changes in asthma symptoms during life phases, including pregnancy and menopause, when sex hormones are dramatically changing.

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Abbreviations

AAMϕ:

alveolar macrophages

AHR:

airway hyperresponsiveness

BAL:

broncheoalveolar lavage

DC:

dendritic cells

FeNO:

forced nitric oxide

HDM:

house dust mite

HRT:

hormone replacement therapy

Mϕ:

macrophages

OVA:

ovalbumin

SARP:

severe asthma research program

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Authors and Affiliations

  1. Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, 37232, USA

    Hubaida Fuseini & Dawn C. Newcomb

  2. Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, 37232, USA

    Dawn C. Newcomb

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  1. Hubaida Fuseini
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  2. Dawn C. Newcomb
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Correspondence to Dawn C. Newcomb.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This work was supported by National Institute of Health: R01 HL122554 and R21 AI121420.

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This article is part of the Topical Collection on Basic and Applied Science

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Fuseini, H., Newcomb, D.C. Mechanisms Driving Gender Differences in Asthma. Curr Allergy Asthma Rep 17, 19 (2017). https://doi.org/10.1007/s11882-017-0686-1

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