Abstract
IntroductionLittle is known about the distribution of asthma severity in men and women in the general population. The objective of our study was to describe asthma severity and change in severity according to gender in a cohort of adult asthmaticsMethodsSubjects with asthma were identified from random samples of the 22 to 44 year-olds from the general population, screened for asthma from 1991 to 1993 in 48 centers from 22 countries and followed-up during 1998–2002, as part of the European Community Respiratory Health Survey (ECRHS). All participants to follow-up with current asthma at baseline were eligible for the analysis. To assess change over the follow-up, asthma severity at the two surveys was defined using standardized data on respiratory symptoms, lung function and medication according to the Global Initiative for Asthma (GINA) Guidelines. Another quantitative score (Ronchetti) further considering hospitalizations was also analysed.ResultsThe study included 685 subjects with asthma followed-up over a mean period of 8.65 yr (min 4.3-max 11.7). At baseline, asthma severity according to GINA was distributed as intermittent: 40.7%, 31.7% as mild persistent, 14% as moderate persistent, and 13.5% as severe persistent. Using the Ronchetti score derived classification, the distribution of asthma severity was 58% mild, (intermittent and mild persistent), 25.8% moderate, and 15.4% severe. Whatever the classification, there was no significant difference in the severity distribution between men and women. There was also no gender difference in the severity distribution among incident cases which developed asthma between the two surveys. Men with moderate-to-severe asthma at baseline were more likely than women to have moderate-to-severe asthma at follow-up. Using GINA, 69.2% of men vs. 53.1% of women (p = 0.09) with moderate-to-severe asthma at baseline were still moderate-to-severe at follow-up. Using Ronchetti score, 53.3% of men vs. 36.2% of women (p = 0.03) with moderate-to-severe asthma at baseline were still moderate-to-severe at follow-up.ConclusionsThere was no gender difference in asthma severity at the two surveys. However, our findings suggest that asthma severity might be less stable in women than in men.
Highlights
Little is known about the distribution of asthma severity in men and women in the general population
In a cross-sectional study from the European Network For Understanding Mechanisms Of Severe Asthma (ENFUMOSA), women were found to dominate the group of subjects with severe asthma as compared to the patients whose asthma was controlled by low doses of inhaled corticosteroids[3]
All current asthmatics identified in European Community Respiratory Health Survey (ECRHS) I and who participated in ECRHS II were eligible for this analysis
Summary
Little is known about the distribution of asthma severity in men and women in the general population. The objective of our study was to describe asthma severity and change in severity according to gender in a cohort of adult asthmatics. Several studies have reported a higher severity of asthma in women than in men, both in the use of health care and in admissions to hospital [1]. In a population-based study, women had a 70% higher risk than men of being admitted to hospital for asthma after controlling for asthma prevalence and smoking [2]. In a high-risk adult asthmatic cohort, two thirds of admissions were women, suggesting that women might suffer from a more severe form of asthma [4]. Women report more dyspnoea [5]
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