Asthmatic Women Research Articles

Smoking and Asthma in Men and Women with Normal Weight, Overweight, and Obesity

Background. There is a complex interrelationship among smoking, body weight, and asthma. It needs to be clarified whether smoking is related to an increased risk of asthma after taking into account for relative body weight. Objective. To examine the association between cigarette smoking and the prevalence of asthma in Canadian men and women with normal weight, overweight, and obesity. Methods. The analysis was based on data from 112,830 Canadians aged 18 years or more who participated in a national survey in 2007–2008. A questionnaire covered the information on prevalent asthma, smoking status, height, weight, and other factors. Logistic regression analysis was used to determine the association between smoking and the prevalence of asthma stratified by sex and body mass index (BMI). Results. The crude prevalence of asthma was 6.6% for men and 9.3% for women. After adjustment for covariates, the odds ratios (ORs) for current smoking associated with asthma was 1.20 [95% confidence interval (CI): 1.01–1.43] for men with normal weight, 0.98 (95% CI: 0.81, 1.18) for overweight men, and 1.02 (95% CI: 0.80–1.30) for obese men. For women, the corresponding adjusted ORs were 1.41 (95% CI: 1.23–1.62), 1.27 (95% CI: 1.05–1.54), and 1.28 (95% CI: 1.03–1.59), respectively. Conclusion. Current smoking was significantly associated with prevalent asthma in all women regardless of their relative body weight. In men, however, the association was only observed in those with under- or normal weight.

The Effect of Peptidoglycan Stimulation on Basophil-Mediated Atopic Responses During Pregnancy and in Newborns

Background. Toll-like receptor (TLR) molecules play critical roles in directing the course of atopic diseases by recognizing specific microbial products that activate immune effector cell function. Objective. We determined if basophils harvested from neonates genetically predisposed to atopic disease had different levels of TLR2 expression and determined whether putative TLR2 ligands mediated cytokine secretion. Methods. Blood samples were collected from 10 asthmatic and 12 healthy women and their newborns. Basophil histamine was measured using the human basophil degranulation test and TLR2 expression was determined using nucleic acid hybridization in situ and flow cytometry. IL-4 levels were quantified by ELISA following allergen stimulation. Results. The basophil degranulation index (DI) in granulocytes harvested from peripheral blood of asthmatic women was assessed following stimulation with either peptidoglycan (PGN) or Dermatophagoides farinae (Df) extract. The DI was significantly higher in atopic women than in healthy controls. Basophils purified from the cord blood of neonates born to atopic mothers produced more IL-4 compared with basophils purified from children born to nonatopic controls. Finally, TLR2 expression at the protein and mRNA levels was upregulated in cord blood basophils from neonates born to mothers with asthma following stimulation with PGN but not Df. Conclusion. These data suggested that TLR2-mediated innate immune responses play a role in augmenting allergic reactions through the modulation of basophil cytokine secretion and histamine release. Microbial components may activate basophils through TLR2 (especially for genetically predisposed infants) to release cytokines associated with an increased incidence of allergic diseases.

The Moderating Influence of Asthma Diagnosis on Biobehavioral Health Characteristics of Women of Reproductive Age

Promoting healthy behaviors to improve pregnancy outcomes requires an understanding of the factors influencing health behaviors among at-risk populations. We hypothesized that women with an asthma diagnosis would have poorer biobehavioral health risk factors and pregnancy outcomes compared to women without an asthma diagnosis. The Central Pennsylvania Women's Health Study (CePAWHS) included a population-based survey examining health status indicators, risk factors and outcomes, and detailed pregnancy histories among 2,002 women (ages 18-45). 213 asthmatics were identified. Compared with Non-asthmatic women (NA), Asthmatic (A) women reported lower rates of excellent health status (45% A vs. 65% NA, P < 0.001), were more likely to be overweight or obese (68% A vs. 50% NA, P < 0.001), and were more likely to have smoked cigarettes during their first pregnancy (25% A vs. 17% NA, P < 0.01). Psychological measures (psychosocial hassles, low self-esteem, depression) were reported more often in asthmatics than non-asthmatics. Also, asthmatics reported a higher incidence of gestational diabetes (10% A vs. 6% of NA, P = 0.05), preterm births (25% A vs. 16% NA, P < 0.01), and had a higher proportion of low birth weight infants (20% A vs. 13% NA, P = 0.03) compared with non-asthmatics. As predicted, asthmatics had poorer biobehavioral risk factors and outcomes compared to non-asthmatics. These findings illustrate the need to target asthmatic women of reproductive age, particularly in this largely rural setting, with interventions to reduce biobehavioral risk factors as part of a strategy to improve pregnancy outcomes.

A Longitudinal Analysis of Complementary and Alternative Medicine Use by a Representative Cohort of Young Australian Women with Asthma, 1996–2006

Background. There is evidence of asthma patients using complementary and alternative medicine (CAM). This article reports the findings of the first ever longitudinal study of CAM use among women with asthma from a large nationally representative sample. Methods. A longitudinal analysis of questionnaires completed in 1996, 2000, 2003, and 2006 as part of the Australian Longitudinal Study on Women's Health. The cohort began with 14,701 randomly selected young women (aged 18–22 years). CAM use was defined as a consultation with a range of complementary practitioners in the 12 months prior to each survey. Statistical analyses included the use of generalized estimating equations. Results. Over the 10-year period, approximately 26% of the women were asthmatic. Asthmatic women were significantly more likely to use CAM (19%, 22%, and 36% for surveys 2–4, respectively) than non-asthmatic women (15%, 20%, and 32% for surveys 2–4, respectively). CAM use increased as time since asthma diagnosis increased. However, only the increase in consultations with a naturopath/herbalist remains statistically significant when the CAM modalities are considered individually alongside asthma status. The longitudinal model suggests that women with asthma are 1.13 (95% CI: 1.05–1.21) times more likely to consult with a CAM practitioner (p< .001). The study also shows that CAM users have a higher dissatisfaction with conventional healthcare services and consultations when compared to CAM non-users. Conclusion. These findings suggest that women with asthma may turn to CAM after conventional care fails to adequately address their healthcare needs.

Sex Differences

We have demonstrated in several studies that obesity and adipokines are more strongly associated with asthma in women than in men. The reason for this controversial sex difference is not known. Based on our previous studies, we hypothesize that sex-related differences in ectopic fat may explain the obesity-asthma association in women.

Asthma, the sex difference

asthma is a common chronic disease with significant clinical impact worldwide. Sex-related disparities in asthma epidemiology and morbidity exist but debate continues regarding the mechanisms for these differences. There is a need to review the recent findings for asthma care providers and to highlight areas in need of additional research. recent data illustrate striking sex-related differences in asthma epidemiology and disease expression. Studies show an increased incidence of asthma in women. Data demonstrate that asthmatic women have a poorer quality of life and increased utilization of healthcare compared to their male counterparts despite similar medical treatment and baseline pulmonary function. Research continues to explore hypotheses for these differences including the potential influences of the female sex hormones, altered perception of airflow obstruction, increased bronchial hyper-responsiveness, and medication compliance and technique. However, no single explanation has been able to fully explain the disparities. women are more likely to be diagnosed with asthma and suffer greater morbidity than men. The physiologic mechanisms for these differences are not well understood. Understanding sex-related differences in asthma and providing patients with education geared toward these disparities are important in establishing effective, individualized asthma management strategies for all patients.

Risk of perinatal mortality associated with inhaled corticosteroid use for the treatment of asthma during pregnancy

Four studies investigating the association between inhaled corticosteroid (ICS) use during pregnancy and perinatal mortality reported no significantly increased risk. These studies must be interpreted with caution because they have insufficient statistical power and a lack of adjustment for potential confounders. We sought to evaluate whether asthmatic women exposed to ICSs during pregnancy are more at risk of perinatal mortality than asthmatic women not exposed. We also sought to estimate the risk of perinatal mortality as a function of the daily ICS dose taken during pregnancy. From the linkage of 3 administrative databases from Quebec, a cohort including 13,004 single pregnancies from asthmatic women was constructed. We used a 2-stage sampling cohort design to obtain information on cigarette smoking from the medical charts of 487 mothers. The final estimates of the odds ratios (ORs) of perinatal mortality were estimated with a logistic regression model. The cohort was formed of 4,140 women who used greater than 0 to 250 μg/d ICS, 1,140 women who used greater than 250 μg/d ICS, and 7,724 nonusers of ICSs during pregnancy. Women exposed to ICSs (any dose) had a nonsignificant increased risk of perinatal mortality (OR, 1.07; 95% CI, 0.70-1.61). The use of greater than 250 μg/d ICS was associated with a nonsignificant 52% increased risk of perinatal mortality (OR, 1.52; 95% CI, 0.62-3.76). The risk of perinatal mortality was not found to be significantly associated with ICS use during pregnancy. The result associated with higher doses of ICSs is limited due to a lack of statistical power and a possibility of residual confounding by asthma severity and control.

Relation of perimenstrual asthma with disease severity and other allergic co-morbidities—the first report of perimenstrual asthma prevalence in Saudi Arabia

Background Perimenstrual asthma (PMA) has been documented in 30–40% of asthmatic women; however, there have been few epidemiological investigations of PMA in practice. Objectives Determination of the prevalence of perimenstrual asthma in a sample of female Saudi asthmatic patients, and to study the relation of PMA to asthma severity, aspirin-induced asthma and to other allergic co-morbidities. Study design Data were analysed from all female asthmatic patients followed up in the unit from January 2008 to May 2009 who were not pregnant, not on oral contraceptive pills, not menopausal, nor had had a hysterectomy. They were asked about exacerbation of their asthma state regarding worsening of symptoms, need for more rescue medications and even visits to emergency room just before or in the first days of menstruation, or both. Moreover, relation with aspirin-induced asthma and other associated allergic co-morbidities recorded in their medical files with prevalence of PMA was reported. Results The prevalence was found to be 8.2%. Asthma severity was found to be significantly related to PMA (p<0.0001). Aspirin-induced asthma and allergic co-morbidities were more prone to occur in cases with PMA than other studied asthmatics. Conclusion We have found a low prevalence of PMA in Saudi women of fertile age compared to other studies published. Study findings support the hypothesis that PMA is related to asthma severity.

Menopausal asthma: a new biological phenotype?

Female hormones play an important role in women's lung health, especially in asthma pathophysiology. Although a growing interest has recently been aroused in asthma related to short-term reproductive states, menopausal asthma has been little studied in the past. The aim of the present study was to explore airway inflammation in menopausal asthmatic women in a noninvasive manner. Forty consecutive women with menopausal asthma, 35 consecutive women with premenopausal asthma and 30 age-matched healthy controls were enrolled in the study. Urinary LTE-4, induced sputum inflammatory cells, and exhaled LTE-4, IL-6, pH, and NO levels were measured in all the subjects enrolled. Women with menopausal asthma showed decreased estradiol concentrations, high sputum neutrophils, and exhaled IL-6. Women with premenopausal asthma presented instead an essentially eosinophilic inflammatory pattern. Higher urine and breath condensate LTE-4 concentrations were found in premenopausal and menopausal asthma compared to controls. Our results substantiate the existence of a new biological phenotype of menopausal asthma that is mainly characterized by neutrophilic airways inflammation and shares several characteristics of the severe asthma phenotype.

Risk of perinatal mortality associated with asthma during pregnancy: a 2-stage sampling cohort study

The association between maternal asthma during pregnancy and perinatal mortality has been investigated in 21 studies, and a significantly increased risk among asthmatic women was found in 4 studies. However, these studies have methodologic limitations, such as lack of adjustment for cigarette smoking, a major risk factor for perinatal mortality. To evaluate whether maternal asthma during pregnancy increases the risk of perinatal mortality. From the linkage of 3 administrative databases from Québec, Canada, a cohort including 13,100 asthmatic and 28,042 nonasthmatic women who had at least 1 pregnancy between 1990 and 2002 was constructed. We used a 2-stage sampling cohort design to obtain information on cigarette smoking and other potential confounders from the medical records of 1,247 selected mothers. In the cohort, 353 cases of perinatal mortality were identified, and we were able to retrieve the medical record of the mother for 304 cases. A significantly increased crude risk of perinatal mortality of 34% among asthmatic women compared with nonasthmatic women was found, but the odds ratio did not remain significant after adjustment for placental abruption and cigarette smoking (odds ratio, 1.12; 95% confidence interval, 0.87-1.45). The risk of perinatal mortality was not found to be significantly associated with maternal asthma after the effect of smoking was removed.

Development of a nomogram for identification of asthma among adults in epidemiologic studies

The criteria used to identify persons with asthma in epidemiologic studies are varying and, depending on the method used, can be challenging and resource consuming. To develop a nomogram (scoring system) to identify adult patients with asthma using a combination of variables collected via a validated questionnaire. We studied the first 268 women aged 40 to 69 years in the Shanghai Women's Asthma and Allergy Study who reported signs and symptoms of asthma and underwent either methacholine challenge testing or test of reversibility during the asthma screening survey between 2003 and 2007. These women were defined as having definite asthma (n=106) or not (n=162). Multivariable logistic regression analysis was performed to develop a predictive model for identifying asthma using survey information alone. Clinically relevant questions were used for the predictive multivariable logistic regression model and included the following: ever wheezing or whistling in the chest, current medication use for asthma, self-reported ever asthma, self-reported ever allergic rhinitis, family history of allergy, and age. The area under the receiver operating characteristic curve of the prediction model was 0.75 (95% confidence interval, 0.69-0.81). A nomogram was developed to assess the individual probability of asthma based on individually weighted variables in the predictive model. In clinical or epidemiologic studies, this asthma nomogram could be used as a tool to assess the probability of asthma for an individual patient by incorporating asthma-related predictor variables obtained through a field questionnaire.

Premenstrual asthma and atopy markers

The frequency of atopy in women with premenstrual asthma (PMA) and its possible effect on the premenstrual exacerbation of asthma are unknown. To analyze the relation between atopy markers (total IgE, Phadiatop, and specific IgE) and PMA. Asthmatic women of reproductive age completed a questionnaire about respiratory symptoms and recorded peak flow during an entire menstrual cycle to be classified as asthmatic patients with or without PMA. Their asthma severity was graded according to the 2005 Global Initiative for Asthma scale. PMA was defined as a clinical or functional exacerbation (>or=20%) in the premenstrual phase compared with the preovulatory phase. Blood tests for several atopy markers were conducted for: total IgE and screening for aeroallergens (Phadiatop) and specific IgE. Blood determinations were performed in 59 asthmatic women, of whom 31 (53%) had PMA. Twenty-six patients with PMA (84%) and 12 without PMA (43%) had total IgE values greater than 100 kU/L (P=.001). Twenty-one patients with PMA (68%) and 14 without PMA (50%) tested positive for Phadiatop (P=.17). Those who were positive for Phadiatop were also tested for specific IgE. No relation was found between specific IgE and PMA; values for ryegrass (63%), olive (60%), and Dermatophagoides pteronyssinus (54%) exceeded 0.35 kU/L. PMA seems to be closely linked to total IgE levels but not to specific allergens. The atopy affects the clinical manifestations of PMA in women of reproductive age.

Frequency of asthma as the cause of dyspnea in pregnancy

Objective To estimate the prevalence of asthma among pregnant women with dyspnea. Methods Pregnant women referred for prenatal care visits who had complaints of dyspnea were included. All pregnant women were evaluated by a respiratory specialist. Spirometry was performed by a single trained physician. Results Asthma was diagnosed in 38.8% of participants. Dyspnea was diagnosed as being physiologic in 36.4% of cases, but 24.8% of cases were of probable asthma (spirometric values were within normal range but symptoms and signs were suggestive of asthma). Cough, wheezing, and post-exercise symptoms were significantly more prevalent in asthmatic and probable-asthmatic women than in women without asthma. Conclusion Dyspnea in pregnancy can be physiologic, but when it is accompanied by other symptoms such as cough or wheezing it is likely to be caused by asthma. Because of the high prevalence of asthma during pregnancy, it seems logical to evaluate dyspnea via physical examination and response to bronchodilators.

Asthma in pregnancy and its pharmacologic treatment

Asthma is among the most common serious medical problems in pregnancy, and its prevalence may be increasing. Management is problematic because asthma may harm the fetus, yet little is known about fetal risks of asthma medications. To examine the prevalence, symptom control, and pharmacologic treatment of asthma in pregnancy. Study participants were a random sample of 3,609 mothers of nonmalformed infants born in Massachusetts between 1998 and 2006. Interviewed within 6 months of delivery, participants were asked specific asthma-related questions and classified as having physician-diagnosed, possible, past, or no asthma; those with physician-diagnosed asthma were classified as having well-controlled, not well-controlled, or poorly controlled asthma. Drug treatments were grouped into corticosteroids, beta(2)-agonists, leukotriene modifiers, combination products, and others. Physician-diagnosed asthma was present in 502 women (13.9%) and possible asthma in an additional 578(16.0%). Higher rates of asthma were observed among women who were younger, white, obese, and less well educated, had lower income, and smoked during pregnancy. Secular changes were unremarkable: leukotriene modifiers were used by only 3.4% of asthmatic women; inhaled steroid use increased only from 19.0% during 1997-1999 to 23.3% in 2003-2005, whereas use of inhaled beta(2)-agonists exceeded 50% in both periods. Less than 40% of women with poorly controlled asthma symptoms reported use of a controller medication. High rates of asthma and asthma symptoms, together with the low rates of use of controller medications, underscore the need to better understand the risks and safety of asthma medications during pregnancy.

Effect of maternal moderate to severe asthma on perinatal outcomes

It has been reported that adverse fetal outcomes are more prevalent in pregnant women with asthma than they are in women without asthma. In our study, we investigated the effect that the severity of asthma during pregnancy has on the risk of a small for gestational age (SGA) infant, low birth weight (LBW), and preterm birth. A population-based cohort of 13,007 pregnancies from asthmatic women was reconstructed through the linking of three of Quebec's (Canada) administrative databases covering the period between 1990 and 2002. A two-stage sampling cohort design was used to collect additional information on the selected women's life-style habits via a mailed questionnaire. Asthma severity during pregnancy was measured with a validated database index. A logistic regression model was used to obtain the adjusted odds ratios of SGA, LBW and preterm birth as a function of the level of asthma severity. The proportions of women with mild, moderate and severe asthma were 82.5%, 12.5% and 5.0%, respectively. We sent 3,168 questionnaires to selected women, with a 40.2% (n=1274) response rate. Final estimates showed that the risk of SGA was significantly higher among severe (OR:1.48, 95%CI: 1.15-1.91) and moderate asthmatic women (OR: 1.30, 95%CI:1.10-1.55) than mild asthmatic women. No significant associations were found between asthma severity, preterm birth and LBW. Mothers with severe and moderate asthma during pregnancy have a higher risk of SGA babies than those with mild asthma.

Mild asthma in overweight women: A new phenotype?

Epidemics of asthma and overweight have been linked recently. They might be associated with systemic inflammation. In asthma hyperresponsiveness to adenosine (AMP) is more closely related to inflammation than to methacholine (MCh). The aim of the study was to determine responsiveness to AMP and MCh in overweight compared with normal weight asthmatics. Thirty women were enrolled (19 overweight) with mild controlled asthma according to GINA. A Body Mass Index (BMI) less than 25kg/m(2) was considered as normal and a BMI above 25kg/m(2) as overweight. We assessed the recent control of asthma (ACQ), pulmonary function tests, bronchial responsiveness to MCh and AMP (PC(20) and O'Connor two-point dose-response slope), perception of symptoms (Borg scale), and blood inflammatory markers (leptin and hs-CRP by ELISA). Overweight had a significant lower dose-response slope of the MCh challenge (p=0.009) as compared to normal weight patients, whereas no significant difference was observed for AMP challenge (p=0.27). Overweight patients had higher intercepts of the Borg scale measured before the MCh and AMP challenge tests (p=0.01 and p=0.03). Plasma leptin (p=0.001) and hs-CRP (p=0.05) concentrations were higher in overweight than normal weight patients. There was no correlation between challenges and inflammatory markers. Overweight asthmatic women have more pronounced systemic inflammation, but are less responsive to MCh. AMP responsiveness appeared to be comparable between both groups. Our findings suggest that overweight asthmatic women do not feature increased airway inflammation, but do represent a distinct phenotype as compared to normal weight patients.

From the female perspective: Long-term effects on quality of life of a program for women with asthma.

Although, among adults, asthma predominates in women, the role of sex and gender in asthma has only recently been studied. Moreover, only one study has focused on the management of asthma by women, reporting that 1 year subsequent to an intervention addressing sex and gender role factors, women's asthma status was improved. Data from a 2-year postintervention follow-up were assessed to determine whether there were longer-term effects on the asthma status and quality of life (QoL) of the participants. A randomized controlled design was used in which female patients with asthma, who were receiving services at the University of Michigan Health System, Ann Arbor, Michigan (2002-2006), were assigned to either a control group or a female-oriented intervention group that focused on management challenges related to sex and gender role factors. Data were collected at baseline and 2 years' postintervention (2008) by telephone interview and review of medical records. Measures included asthma-related QoL, health care and medication use for asthma, level of self-regulation, self-confidence in managing the condition, sex and gender role-related asthma problems, and days of missed work or school because of asthma. Data were analyzed using both generalized estimating equations logistic regression and log-linear regression. The mean (SD) age of the 808 women participating in the study was 48.2 (13.1) years in the intervention group and 48.7 (14.3) years in the control group, and the percentage of minority participants was 15.8% and 16.3%, respectively. Despite randomization, women in the intervention group had more persistent asthma at baseline. At 2 years' postrandomization, the only significant difference in health care use was associated with scheduled office visits; no other significant health care use differences were evident. However, the women in the intervention group had a significantly greater decrease of asthma symptoms with sexual activity (P = 0.01) and greater reduction in days of work/school missed for asthma in winter months (P = 0.03), were better able to self-regulate (P = 0.01), were more confident in managing their asthma (P = 0.01), and had higher levels of asthma-related QoL (P = 0.02). They also had a greater reduction in the use of short-acting bronchodilators (ie, rescue medications) than did women in the control group (P < or = 0.05). An intervention that focuses on female-specific aspects of asthma management may result in improved QoL and health status for women with asthma, as was evident 2 years' postintervention in this study.

Asthma in pregnancy – from immunology to clinical management

Asthma is one of the most common chronic medical conditions that may complicate pregnancy. Asthma influences the outcome of pregnancy and, vice versa, pregnancy affects asthma severity, but the underlying immunological mechanisms of this interaction are not fully understood. As a sign of pregnancy-induced immunotolerance, attenuation of allergic responses can be detected in controlled asthmatic pregnant patients; however non controlled asthmatic pregnant women show significant asthma-associated immune reactions that may, beside other factors, influence fetal growth. Generally, although uncontrolled asthma may increase the risk of adverse perinatal outcomes, women with well-controlled and adequately treated disease during pregnancy do not develop maternal or fetal complications.

Adverse Perinatal Outcomes in Asthmatic Women: A Meta Analysis from Published Data

RATIONALE: This meta-analysis was conducted to investigate whether maternal asthma is associated with an increased risk of pregnancy and neonatal complications and if active medical management of asthma can influence these outcomes.

Asthma in pregnancy - from immunology to clinical management.

Asthma is one of the most common chronic medical conditions that may complicate pregnancy. Asthma influences the outcome of pregnancy and, vice versa, pregnancy affects asthma severity, but the underlying immunological mechanisms of this interaction are not fully understood. As a sign of pregnancy-induced immunotolerance, attenuation of allergic responses can be detected in controlled asthmatic pregnant patients; however non controlled asthmatic pregnant women show significant asthma-associated immune reactions that may, beside other factors, influence fetal growth. Generally, although uncontrolled asthma may increase the risk of adverse perinatal outcomes, women with well-controlled and adequately treated disease during pregnancy do not develop maternal or fetal complications.