Monica Kraft, MD: Asthma in Women

Monica Kraft, MD

A discussion hosted at the CHEST 2019 Annual Meeting in New Orleans this week showed the very particular means by which chronic obstructive pulmonary disease (COPD) affects female patients compared to male counterparts.

As also discussed at CHEST, asthma rates vary between genders—though there’s a more firm grasp on the what drives the trends, and when.

In an interview with MD Magazine®, Monica Kraft, MD, Department of Medicine chair at the University of Arizona College of Medicine — Tucson, detailed her session on interpreting gender sex differences in lung disease, and what clinicians need to know when monitoring and caring for women at risk of asthma.

MD Mag: What was the focus of your session on gender sex differences in lung disease?

Kraft: So we covered 2 topics: lung cancer, and asthma. It had 2 speakers: Dr. Lynn Tanoue from Yale, and me.

MD Mag: Speaking particularly to asthma, what does the differentiation look like?

Kraft: The differentiation, with regards to asthma and gender, is quite pronounced, in that asthma is much more common in boys—and then it switches at puberty. And then in adulthood, it's much more common in women, even through postmenopausal years. And then in the very older age— 70s, 80s—it seems like the genders come together, and the prevalence is similar.

MD Mag: Are there any differentiations in screening factors, or issues in interpreting symptoms? That seems to be a big issue in cardiovascular disease—that a woman may present with the exact same symptoms as a man, and during an assessment, it's just dismissed.

Kraft: That's a good point. I think we have more of an awareness that asthma is more common in women. But I think one of the bigger issues is wheezing, coughing, and shortness of breath can be other things besides asthma.

So maybe it's not as much of a gender issue, as opposed to making the right diagnosis, because there are other lung diseases and cardiac diseases that can cause wheezing. They're saying all that wheezes isn't asthma. It's important to make that diagnosis.

MD Mag: Regarding the drivers of asthma: is there any difference that we see between the genders or even in patient age?

Kraft: Certainly, the hormonal levels are probably the biggest differentiation, if we're going to think about asthma and gender. So certainly, puberty and in young adulthood, estradiol or estrogen levels can actually potentiate certain types of inflammation relevant to asthma.

And animal studies have even shown this—even in male versus female mice. And then in humans, of course. So we think that the hormones play a particular role.

MD Mag: Do we see any differentiation in therapy and treatment response? Are there different recommended therapies?

Kraft: There can be some differences in therapy. I think the most obvious example is a sort of premenstrual asthma—meaning, it's worst right before menses. And in that case, there I'll often make therapeutic changes on a monthly basis to really address that, and even consider using oral contraceptives in that case, for that reason. Obviously, they have other effects as well. But oral contraceptives can help.

MD Mag: Are there any big takeaway messages that clinicians should take when trying to understand the differentiation, and managing women with asthma?

Kraft: I think that asthma is more common in women, so it is more likely to be a diagnosis of a patient who presents with wheezing, coughing, shortness of breath. I think that's something to consider.

What we don't entirely know is whether they're less responsive to medications or not. I don't think that's necessarily been borne out. But certainly we want to think about how especially asthma and aging can also be an issue. So if you have this intersection of age and gender, that can really increase the prevalence of the disease. This is more of an awareness—that it's more likely to be asthma in a woman versus a man who might present with similar symptoms.