Wheezing. Chest tightness. Difficulty breathing. Inhalers and oral steroids can quiet these asthma symptoms. But a bad asthma attack will land you in the emergency room or hospital.
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Severe asthma is most likely to send two groups of patients to the hospital, a Cleveland Clinic study finds: women aged 40 to 60 and boys aged 1 to 10.
“Treating both of these groups in the same way may not be the right thing to do,” says pulmonary medicine expert Joe Zein, MD. “Better targeted treatments may be more effective in keeping them out of the hospital.”
A rise in asthma
The incidence of asthma is increasing. Nearly 26 million Americans have asthma; at least 7 million are children.
Hospital care for asthma is helping to drive up U.S. healthcare costs. “The 10 percent of patients with severe asthma account for 50 percent of the costs of asthma care,” says Dr. Zein.
Correlating asthma-related hospitalizations with severe asthma, his team combed a large U.S. database for trends over the years 2011 and 2012.
“We saw the same two peaks in hospital admissions for asthma — boys aged 1 to 10 and women aged 40 to 60 — across all races and ethnicities,” he notes. Women represented two-thirds of the 400,000 annual hospitalizations. And of the 1,000 asthma patients who died each year, more were women.
Sex hormones and your lungs
Over a lifetime, the waxing and waning of sex hormones impacts asthma.
Between ages 4 and 14, asthma is more common among boys. But at puberty, asthma becomes more common and more severe in females. This trend reverses itself after menopause, when severe asthma becomes more common among older men.
“Sex hormones have many different effects on the lungs, and we’re not sure why,” says Dr. Zein. “For example, progesterone may impact the clearing of mucus from the airways.”
His team recently linked lower testosterone and progesterone levels and higher estradiol levels to reduced lung function in men and women with severe asthma.
The impact of menopause
In his report, Dr. Zein suggests that menopause may protect women from severe asthma. Beyond the age of 45, the risk of severe asthma does not increase any further in women as compared to men. “However, hormone replacement therapy (HRT) may worsen asthma control and erase the protection that menopause offers,” he cautions.
For that reason, Dr. Zein advises menopausal women with asthma to avoid HRT unless absolutely necessary. “If asthma should worsen, HRT should probably be stopped,” he says.
Prior to menopause, birth control pills can ease asthma symptoms in women with premenstrual asthma by smoothing out hormonal swings. However, taking non-steroidal anti-inflammatory drugs like Motrin® for painful cramps can worsen asthma, he notes.
The impact of puberty
Young boys are three times more likely to be hospitalized for asthma than young girls. “That increased severity may be due to boys’ proportionately smaller airways and lungs,” says Dr. Zein.
At puberty, boys often “outgrow” asthma as testosterone levels rise. In contrast, puberty is when girls typically develop asthma for the first time.
Outdoor asthma triggers may also make a difference. In the past, boys spent more time outdoors than girls. While fewer kids spend time outdoors today, that difference may persist and partly explain increased asthma severity among boys.
For all asthma patients, sex hormones seem to make a difference across the lifespan. “We should be thinking about potential differences in age, gender and other factors to better personalize asthma treatment,” Dr. Zein concludes.