Asthmatic Women Research Articles

The evaluation of asthma by gender and age groups in Turkey, in 1990-2019: incidence, prevalence, mortality, and disability-adjusted life years

Aims: The aim of this study was to evaluate the incidence and prevalence of asthma, asthma-related DALYs and deaths, and risk factors for asthma by genders and age groups during the study years in Turkey. Methods: The data used in the study were obtained from the estimation data prepared by the Institute for Health Metrics and Evaluation on asthma for Turkey by the global burden of disease study covering the years 1990-2019. During the study years period, death from asthma and Disability-Adjusted Life Years (DALYs) were used as dependent variables. In addition, the effects of Occupational Asthmagens (OA), Smoking (SM), and High Body Mass Index (HBMI), which are known as risk factors for asthma-related deaths and DALYs, were investigated. Comparisons of the variables according to gender and age groups were made with the Mann-Whitney test. The relationships between the variables were examined with the Spearman rank correlation coefficient (Rho). Results: A statistically significant difference was found between the mean rank of total prevalence number, total incidence number, total number of deaths and DALYs scores by gender. Asthma-related deaths due to risk factors (OA, HBMI, SM) were found to be correlated with DALYs and the total number of asthma deaths. Total asthma deaths, and asthma-related deaths because of HBMI and DALYs because of HBMI-induced asthma in women; deaths from asthma because of OA, SM, and DALYs from asthma because of OA and SM were found to be higher in males. Conclusion: HBMI in women and SM and OA in men stand out as risk factors. Therefore, as a result of a detailed investigation of the risk factors leading to the development of asthma, policies should be developed for gender and age groups, and necessary precautions should be taken.

Investigation of Airway Obstruction Severity Based on Plasma Visfatin Level in Asthmatic Women

Introduction:: Bronchial asthma is a chronic disorder with high prevalence among wom-en. Visfatin as a pro-inflammatory adipokine has been linked to inflammatory lung diseases such as asthma and can be used as a forthcoming biomarker target to diagnose and treat asthmatic patients. Aim:: The aim of this study is to evaluate plasma visfatin level and its correlation with pulmonary function of female asthmatic patients. Methods: This cross-sectional study was conducted on all female asthmatic patients referred to the Be'sat Pulmonary Clinic of Kerman from 1 November 2019 to 20 February 2020. Patients with con-firmed diagnosis of asthma were included. The data were collected through a checklist and the cor-responding author conducted all face-to-face interviews in the physician’s office of the pulmonary clinic. Then, blood samples (5 cc) were taken from the patients to determine the plasma level of visfatin. Data was analyzed by SPSS Software. Results: 113 women with asthma were studied. The mean ± SD age of patients was 46.71 ± 13.91 years (range: 13 to 75). The mean ± SD of visfatin plasma levels was 26.30 ± 6.98 mg/dl (range: 8.50 to 46.88). The forced expiratory volume in the first second (FEV1) had a significant and negative correlation with plasma visfatin concentrations (P-value = 0.03). Conclusion: The results of this study indicated that plasma visfatin levels were correlated inversely with FEV1 among asthmatic women. Further studies with large samples are recommended to evaluate the role of visfatin in asthma pathogenesis.

Do improvements in clinical practice guidelines alter pregnancy outcomes in asthmatic women? A single-center retrospective cohort study

Objective Asthma occurs in ∼17% of Australian pregnancies and is associated with adverse perinatal outcomes, which worsen with poor asthma control. Consequently, the South Australian ‘Asthma in Pregnancy’ perinatal guidelines were revised in 2012 to address management according to severity. This study investigated if these revised guidelines reduced the impact of maternal asthma on risks of adverse perinatal outcomes before (Epoch 1, 2006–2011) and after the revision (Epoch 2, 2013–2018). Methods Routinely collected perinatal and neonatal datasets from the Women’s and Children’s Hospital (Adelaide, Australia) were linked. Maternal asthma (prevalence:7.5%) was defined as asthma medication use or symptoms described to midwives. In imputation (n = 59131) and complete case datasets (n = 49594), analyses were conducted by inverse proportional weighting and multivariate logistic regression, accounting for confounders. Results Overall, maternal asthma was associated with increased risks of any antenatal corticosteroid treatment for threatened preterm birth (aOR 1.319, 95% CI 1.078–1.614), any Cesarean section (aOR 1.196, 95% CI 1.059–1.351), Cesarean section without labor (aOR 1.241, 95% CI 1.067–1.444), intrauterine growth restriction (IUGR, aOR 1.285, 95% CI 1.026–1.61), and small for gestational age (aOR 1.324, 95% CI 1.136–1.542). After guideline revision, asthma-associated risks of any Cesarean section (p < 0.001), any antenatal corticosteroids (p = 0.041), and small for gestational age (p = 0.050), but not IUGR and Cesarean section without labor, were reduced. Conclusions Clinical practice guidelines based on the latest evidence do not guarantee clinical efficacy. Since adverse perinatal outcomes did not all improve, this work highlights the need to evaluate the ongoing impact of guidelines on clinical outcomes.

Steady-state estradiol triggers a unique innate immune response to allergen resulting in increased airway resistance

RationaleAsthma is a chronic airway condition that occurs more often in women than men during reproductive years. Population studies have collectively shown that long-term use of oral contraceptives decreased the onset of asthma in women of reproductive age. In the current study, we hypothesized that steady-state levels of estrogen would reduce airway inflammation and airway hyperresponsiveness to methacholine challenge.MethodsOvariectomized BALB/c mice (Ovx) were implanted with subcutaneous hormone pellets (estrogen, OVX-E2) that deliver consistent levels of estrogen [68 ± 2 pg/mL], or placebo pellets (OVX-Placebo), followed by ovalbumin sensitization and challenge. In conjunction with methacholine challenge, immune phenotyping was performed to correlate inflammatory proteins and immune populations with better or worse pulmonary outcomes measured by invasive pulmonary mechanics techniques.ResultsHistologic analysis showed an increase in total cell infiltration and mucus staining around the airways leading to an increased inflammatory score in ovarectomized (OVX) animals with steady-state estrogen pellets (OVX-E2-OVA) as compared to other groups including female-sham operated (F-INTACT-OVA) and OVX implanted with a placebo pellet (OVX-Pl-OVA). Airway resistance (Rrs) and lung elastance (Ers) were increased in OVX-E2-OVA in comparison to F-INTACT-OVA following aerosolized intratracheal methacholine challenges. Immune phenotyping revealed that steady-state estrogen reduced CD3+ T cells, CD19+ B cells, ILC2 and eosinophils in the BAL across all experiments. While these commonly described allergic cells were reduced in the BAL, or airways, we found no changes in neutrophils, CD3+ T cells or CD19+ B cells in the remaining lung tissue. Similarly, inflammatory cytokines (IL-5 and IL-13) were also decreased in OVX-E2-OVA-treated animals in comparison to Female-INTACT-OVA mice in the BAL, but in the lung tissue IL-5, IL-13 and IL-33 were comparable in OVX-E2-OVA and F-INTACT OVA mice. ILC2 were sorted from the lungs and stimulated with exogenous IL-33. These ILC2 had reduced cytokine and chemokine expression when they were isolated from OVX-E2-OVA animals, indicating that steady-state estrogen suppresses IL-33-mediated activation of ILC2.ConclusionsTherapeutically targeting estrogen receptors may have a limiting effect on eosinophils, ILC2 and potentially other immune populations that may improve asthma symptoms in those females that experience perimenstrual worsening of asthma, with the caveat, that long-term use of estrogens or hormone receptor modulators may be detrimental to the lung microenvironment over time.

The effects of inhaled corticosteroids on bone mineral density, bone formation/resorption markers and quality of life in premenopausal asthmatic women

The effects of inhaled corticosteroids on bone mineral density, bone formation/resorption markers and quality of life in premenopausal asthmatic women

Laryngeal dysfunction is prominent in asthmatic women treated by inhaled corticosteroids.

Dysphonia is a frequent comorbidity of asthma and has been suggested to be a local side effect of inhaled corticosteroids due to laryngeal candidiasis. We hypothesized that dysphonia in asthmatics was not due to laryngeal organic lesions but to laryngeal dysfunction during phonation (LDP). We compared the frequency of LDP in female asthmatic patients treated with inhaled corticosteroids to female controls. We compared 68 asthmatic female patients to 53 female control subjects. Pulmonary function tests were performed and the asthmatic patients classified according to the level of inhaled corticosteroids. Dysphonia was defined as a Vocal Handicap Index ≥18 or GRBAS score ≥2. All patients underwent video laryngo-strobe examination, analyzed blindly and separately by two otolaryngologists, describing mucosal changes, LDP, or Organic lesions linked to Laryngeal Dysfunction during Phonation (OLDP). 66.2% of the asthmatic patients exhibited dysphonia and 11.3% of controls (p<0.001). No laryngeal candidiasis was found, only 3 patients presented laryngeal mucosa inflammation. LDP was observed in 60.3% of asthmatic patients and 18.9% of controls (p<0.001), and no difference was found for OLDP (11.8% vs. 13.2%). No association was made between LDP, the dosage of inhaled corticosteroid, and bronchial obstruction. Asthmatic patients were more dysphonic than control subjects. This phenomenon was not explained by mucosal inflammation, laryngeal candidiasis or OLDP. Asthmatic patients had more LDP than controls. There was no relation between LDP, inhaled corticosteroids dosage or bronchial obstruction. These results change our view of inhaled corticosteroid side effects in female asthmatic patients.

IL-33 induces NF-κB activation in ILC2 that can be suppressed by in vivo and ex vivo 17β-estradiol.

Asthmatic women tend to develop severe airway disease in their reproductive years, and 30%-40% of asthmatic women have peri-menstrual worsening of asthma symptoms. This indicates that fluctuations in ovarian hormones are involved in advancement of asthmatic disease and exacerbation of symptoms. Group 2 innate lymphoid cells, or ILC2, are readily detected in allergic conditions, such as rhinosinusitis, in individuals that develop nasal polyps do to allergen exposures, and in allergic asthma. ILC2 are airway localized immune cells activated by IL-33, an innate cytokine that perpetuates allergic inflammation by driving the production of IL-5 and IL-13. We have previously shown that ILC2 are highly activated in naïve and ovalbumin (OVA) challenged, female BALB/c mice in comparison to male mice following stimulation with IL-33. Here, we investigated the effect of steady-state ovarian hormones on ILC2 and the NF-κB signaling pathway following OVA sensitization and challenge. We found that estrogen-treated ovariectomized mice (OVX-E2) that had been challenged with OVA had reduced IL-5 and IL-13 production by lung ILC2 as compared to lung ILC2 isolated from intact male and female sham-operated controls that had been treated with OVA. ILC2 were isolated from untreated animals and co-cultured ex vivo with and without estrogen plus IL-33. Those estrogen-treated ILC2 similarly produced less IL-5 and IL-13 in comparison to untreated, and had reduced NF-κB activation. Single-cell RNA sequencing showed that 120 genes were differentially expressed in male and female ILC2, and Nfkb1 was found among top-ranked regulatory interactions. Together, these results provide new insight into the suppressive effect of estrogen on ILC2 which may be protective in female asthmatics. Understanding further how estrogen modulates ILC2 may provide therapeutic targets for the treatment of allergic diseases.

Serum 25-hydroxyvitamin D deficiency is associated with atopy, and sex may be an effect modifier of its association with asthma in teenagers from northeast Brazil.

Sufficient vitamin D (25-hydroxyvitamin D [25(OH)D]) serum levels are associated with decreased asthma symptoms. Our aim was to investigate associations between vitamin D and atopy, asthma, asthma severity, and asthma phenotypes in Brazilian teenagers. This cross-sectional study involved 942 individuals (11-19 years old) engaged in an asthma cohort. The ISAAC questionnaire was employed to diagnosis asthma and asthma severity. Serum allergen-specific immunoglobulin E (sIgE) was measured by ImmunoCap and serum 25(OH)D was measured by ELISA. We calculated the correlation between sIgE and 25(OH)D. We used multivariate logistic regression analysis to assess associations of interest. We found that 25(OH)D deficiency was positively associated with atopy (OR 1.45, confidence interval [CI] 1.05-2.00) and high levels of this vitamin negatively correlated with sIgE to Dermatophagoides pteronyssinus (r = -0.11, p = 0.019). The average 25(OH)D serum level was 27.0 ± 9.5 ng/ml; 366 individuals (38.8%) had a sufficient level. There was no association between 25(OH)D and asthma, asthma severity or asthma phenotypes in the population. However, sex was a possible effect modifier of the association between vitamin D and asthma: insufficiency in asthmatic women (86%) was higher than in asthmatic men (42%), and there was an association between insufficient vitamin D levels and greater asthma risk only in women (OR = 3.06, 95% CI 1.16-8.07). We have shown that vitamin D deficiency was associated with greater risk of atopy in both sexes and vitamin D insufficiency was associated with asthma only in women. There was no association between vitamin D levels and asthma phenotypes or asthma severity.

ASTHMA EXACERBATION DUE TO ORAL CONTRACEPTIVE PILLS

ASTHMA EXACERBATION DUE TO ORAL CONTRACEPTIVE PILLS

Influence of sex, cigarette smoking and airway inflammation on treatable traits in CBIOPRED severe asthma.

Influence of sex, cigarette smoking and airway inflammation on treatable traits in CBIOPRED severe asthma.

Asthma in a prospective cohort of rural pregnant women from Sri Lanka: Need for better care during the pre-conceptional and antenatal period.

To describe the epidemiology and the effect of asthma on pregnancy outcomes in pregnant women from a rural geography. We conducted a prospective cohort study in Anuradhapura district, Sri Lanka enrolling all eligible pregnant women registered in the maternal care program. An interviewer-administered questionnaire-based symptom analysis and clinical assessment was conducted in the first and second trimesters. We recruited 3374 pregnant women aged 15-48 years at conception. Self-reported physician-diagnosed asthma prevalence was 6.6% (n = 223) with only 41.7% (n = 93) on regular medical follow-up for asthma. The prevalence of wheeze reduced from pre-pregnancy (67.0%) to the first (46.4%) and second trimesters (47.7%; p<0.01). Of the 73 asthmatic women who did not have wheeze in the last 3 months preceding pregnancy, new-onset wheeze was reported by 6(8.2%) and 12(16.4%) in the first and second trimester, respectively. Pregnant women who sought medical care for asthma in the private sector had a lower likelihood of developing new-onset wheeze in the first trimester (p = 0.03; unadjusted OR = 0.94;95%CI 0.89-0.99). Thirty-four (33.3%) pregnant women had at least one hospital admission due to exacerbation of wheeze during the first and second trimester. The prevalence of low birth weight (16.0%) was higher among pregnant asthmatic women. This study reports the high prevalence of asthma and asthma-associated pregnancy outcomes in women from a rural geography signifying the importance of targeted management.

Asthma, Asthma Like Symptoms Prevalance And Affectıng Rısk Factors In Textıle Workers

Bu araştırma tekstil fabrikalarında çalışan, astım tanısı almış veya astım benzeri semptomları olan işçilerin prevalansını ve astım gelişimini etkileyen risk faktörlerini belirlemek amacıyla yürütülen kesitsel tipte bir araştırmadır. Temmuz- Eylül 2019 tarihleri arasında Hatay ilinde tekstil fabrikalarında çalışan 1500 tekstil işçisi araştırmanın evrenini, araştırmayı kabul eden fabrikalardaki 462 işçi ise araştırmanın örneklemini oluşturmuştur. Anket formu; “Avrupa Topluluğu Solunum Sağlığı Anketi” faz I formu esas alınarak, literatür doğrultusunda araştırmacı tarafından geliştirilmiştir. Analizler SPSS 25.0 programında; sayı, yüzde, ortalama, ki kare, Mann Whitney U testiyle yapılmıştır. &#x0D; Mesleksel astım prevalansı %4,9, astım benzeri semptom prevalansı ise %64,9 olarak saptanmıştır. Çalışmada kadınlarda şimdiki astım olma riski erkeklere göre daha yüksek bulunmuştur. Atopi semptomu olan işçilerde, astım ve astım benzeri semptomların daha fazla görüldüğü tespit edilmiştir. Sigara içen işçilerde şimdiki astım olma durumu belirgin olarak sigara içmeyen işçilerden daha fazla bulunmuştur. Maske kullanmayan işçilerde astım benzeri semptomlara daha sık rastlanılmaktadır. Bu araştırmada toza maruz kalım süreleri, çalışma departmanları ve vücut kütle indeksi ile astım ve astım benzeri semptomlar arasında istatistiksel olarak bir ilişki bulunamamıştır.&#x0D; Sonuç olarak, astım prevalansı %4,9 iken, astım benzeri semptom prevalansının %64,9 olması işçilerin yarısından fazlasının astıma aday olduğunu göstermektedir. Bu sonuçlar doğrultusunda işçilerin sigara bırakmalarına yönelik programların geliştirilmesi, toza maruziyetin azaltılması konusunda önlemler alınması ve maske kullanımının desteklenmesi önerilmektedir.

Sex-specific associations of comorbidome and pulmorbidome with mortality in chronic obstructive pulmonary disease: results from COSYCONET

In patients with COPD, it has not been comprehensively assessed whether the predictive value of comorbidities for mortality differs between men and women. We therefore aimed to examine sex differences of COPD comorbidities in regard with prognosis by classifying comorbidities into a comorbidome related to extrapulmonary disorders and a pulmorbidome, referring to pulmonary disorders. The study population comprised 1044 women and 1531 men with the diagnosis of COPD from COSYCONET, among them 2175 of GOLD grades 1–4 and 400 at risk. Associations of comorbidities with mortality were studied using Cox regression analysis for men and women separately. During the follow-up (median 3.7 years) 59 women and 159 men died. In men, obesity, hypertension, coronary artery disease, liver cirrhosis, osteoporosis, kidney disease, anaemia and increased heart rate (HR) predict mortality, in women heart failure, hyperuricemia, mental disorders, kidney disease and increased HR (p < 0.05 each). Regarding the pulmorbidome, significant predictors in men were impairment in diffusion capacity and hyperinflation, in women asthma and hyperinflation. Similar results were obtained when repeating the analyses in GOLD 1–4 patients only. Gender differences should be considered in COPD risk assessment for a tailored approach towards the treatment of COPD.Clinical Trial Registration: ClinicalTrials.gov NCT01245933.

Kisspeptin Reduces Airway Hyperreactivity and Remodeling in Asthmatic Ovariectomized Mice

RationaleEpidemiological data show changes in asthma occurrence with age and sex. After puberty, increased severity in women shows sex‐skewed occurrence of asthma in females vs. males. This implies the importance of female sex‐steroids, particularly estrogen in asthma pathophysiology. Greater asthma in women may represent detrimental mechanisms upstream to or independent of estrogen. Moreover, data from CNS studies show kisspeptin (Kp) signaling is modulated by estrogen. Our recent in vitro studies show Kp via its receptor, KISS1R regulates airway smooth muscle (ASM) cell proliferation. However, the relevance of endogenous estrogen on Kp/KISS1R signaling and their effect on regulating airway hyperresponsiveness (AHR) and remodeling is not yet explored. Accordingly, in this present study, we utilized intact female vs. ovariectomized (OVX) mice to isolate estrogen influence from the Kp effect in regulating AHR and remodeling in a murine model of allergic asthma.MethodsWild Type C57BL/6J intact female and OVX mice were procured from Jackson Laboratory, USA, and challenged intranasally with a mixed‐allergen (MA) for 28 days. On alternate days, animals from the treatment group received intranasal Kp‐10 (1.2mg/kg), vehicle group received PBS alone. On day 29, mice were anesthetized and subjected to SCIREQ flexiVent to measure lung mechanics like airway resistance (Rrs), elastance (Ers), compliance (Crs), tissue damping (G), and tissue‐elasticity (H). Following this, bronchoalveolar lavage (BAL) was performed for differential leukocyte count (DLC) and lung tissues were processed for histology using hematoxylin and eosin (H&amp;E) and trichrome staining. Additionally, laser‐capture microdissection (LCM) assisted qRT‐PCR analysis in ASM cells was performed for genes relevant to airway remodeling.ResultsMA‐challenged intact female and OVX mice showed a significant increase in Rrs, Ers, G, H, and reduced Crs compared to PBS, more pronounced effects were observed in intact females. Kp‐10 treatment significantly reversed the MA‐induced changes with a decrease in Rrs, Ers, G, H, and increased Crs. Interestingly, in OVX mice we observed significant effects of Kp‐10 to improve the lung mechanics compared to intact females. Notably, Kp‐10 alone exposed group did not show any changes in lung mechanics compared to PBS. DLC in BAL showed Kp‐10 treatment significantly reduced MA‐induced inflammatory cell infiltration. Futhermore, histology studies showed Kp‐10 treatment significantly reduced MA‐induced smooth muscle mass and collagen deposition in airways.ConclusionOverall, this study shows the modulatory role of estrogen in regulating kisspeptin signaling, thereby AHR and remodeling. Thus, providing the relevance to higher asthma incidence and severity in women compared to men.

Obesity and abdominal obesity are risk factors for airway obstructive diseases in Korean women: nationwide population-based cohort study.

Existing studies show that women are more susceptible to chronic obstructive pulmonary disease (COPD) and asthma, and that obesity affects the risk of these airway obstructive diseases. We aimed to determine the effect of body mass index (BMI) and waist circumference (WC) on COPD and asthma development in premenopausal and postmenopausal women. This nationwide population-based cohort study included 1,644,635 women ages ≥30 years without diagnosis of COPD or asthma, who underwent national cancer screening in 2009. We classified them as premenopausal and postmenopausal women based on their menopause status at the time of cancer screening. Baseline BMI and WC were measured, and they were classified into five BMI groups (<18.5 kg/m2, 18.5-23 kg/m2, 23-25 kg/m2, 25-30 kg/m2, and ≥30 kg/m2) and WC groups (<60 cm, 65-75 cm, 75-85 cm, 85-95 cm, and ≥95 cm). The hazard ratios (HRs) for COPD and asthma were measured for each group. Regardless of the menopausal status, the high BMI and WC groups had a significantly higher COPD and asthma incidence than that of the normal group, and the HRs increased further with increases in BMI and WC. However, the HR in the underweight group was significantly higher among the postmenopausal women. The HR for asthma in the obese group was significantly higher for both premenopausal and postmenopausal women. The HR for COPD was significantly higher in the group with a WC of ≥95 cm for both premenopausal and postmenopausal women, respectively; the HR for asthma was also significantly higher in this group. Obesity and abdominal obesity are risk factors for COPD and asthma in premenopausal and postmenopausal Korean women. Controlling weight and maintaining a healthy body shape can help prevent COPD and asthma in women.

Sex Disparities in Asthma Development and Clinical Outcomes: Implications for Treatment Strategies.

A gender-related disparity exists in asthma morbidity and mortality, which shifts at around puberty from a male predominance to a female predominance. This is clinically reflected in the fact that asthma that occurs in childhood (childhood-onset asthma) mainly affects boys, and that asthma that occurs in adulthood (adult-onset asthma) mainly affects women. Adult-onset asthma is often non-atopic, more severe, and associated with a poorer prognosis, thus posing a marked burden to women’s health and healthcare system. Many factors have been indicated to explain this gender-related disparity, including sociocultural and environmental factors as well as biological sex differences (genetic, pulmonary and immunological factors). It has long been suggested that sex hormones may be implicated in at least these biological sex differences. Overall, the evidence remains equivocal for the role of most sex hormones in asthma pathogenesis and clinical outcomes. Well-designed randomized clinical trials are required assessing the potential preventive or therapeutic effects of hormonal contraceptives on asthma in women, thereby helping to advance the evidence to inform future practice guidelines. The mechanisms underlying the role of sex hormones in asthma are complex, and our understanding is not yet complete. Additional mechanistic studies elucidating sex hormone signaling pathways and their interactions involved in the pathogenesis and clinical manifestations of asthma will help to identify potential sex hormone-driven asthma endotypes and novel therapeutic targets, providing the basis for a more personalized asthma management strategy.

Asthma severity and impact on perinatal outcomes: an updated systematic review and meta-analysis.

Large-scale studies exploring the associations of asthma severity, exacerbations and medication use with adverse perinatal outcomes have been published in recent years. To update evidence on the associations of asthma severity, exacerbations and medication use with the adverse perinatal outcomes of preterm delivery (PD), low birthweight (LBW) and small-for-gestational-age (SGA). PubMed, Embase, Wanfang, and China National Knowledge Infrastructure (CNKI) from inception to 1 January 2021. Cohort studies comparing the likelihood of adverse perinatal outcomes in groups of asthmatic women stratified by asthma severity, asthma exacerbations or medication use, or comparing the likelihood of adverse perinatal outcomes between non-asthmatic women and asthmatics of various levels of severity and exacerbation. Two authors independently extracted data and assessed risk of bias. Random-effects models were used to meta-analyse the results. Twenty studies met the inclusion criteria. The odds of delivering SGA babies increased with maternal asthma severity. Pregnant women with an asthma exacerbation had higher odds of delivering LBW babies and SGA babies, compared with pregnant women with asthma but without an exacerbation (pooled adjusted odds ratio [OR] 1.15, 95% CI 1.02-1.29 for LBW; number of studies with adjusted OR 3; I2 = 0%) (pooled adjusted OR 1.13, 95% CI 1.04-1.23 for SGA; number of studies with adjusted OR 4; I2 = 0%) and compared to pregnant women without asthma. Oral corticosteroids use during pregnancy was associated with increased odds of LBW, but not PD. The available data suggest that maternal asthma severity and exacerbations are associated with increased odds of LBW and SGA babies. A systematic review and meta-analysis found that maternal asthma severity and exacerbations are associated with increased odds of delivering low birthweight and small-for-gestational-age babies.

Maternal asthma during pregnancy and extremes of body mass index increase the risk of perinatal mortality: a retrospective cohort study

Objective Asthma during pregnancy and extremes of body mass index (BMI) are independently associated with adverse pregnancy outcomes but the impact of the two conditions combined are currently unknown. The aim of this study was to determine the contribution of maternal BMI to adverse birth outcomes in pregnancies complicated by asthma. Methods The study utilized the routinely collected perinatal data on births at the Mater Mother’s Hospital Brisbane, Australia, from January 2008 to December 2019. BMI was grouped as underweight (<18.5), normal weight (18.5-<24.99), overweight (25-29.99), and obese (≥30) and the population split by the presence and absence of maternal asthma. The comparison group was normal BMI, non-asthmatic pregnant women. A modified Poisson regression with robust variance was used to estimate the relative risk. Results In a retrospective cohort study of 110,057 pregnant women, 17.08% of women had asthma. Asthma and BMI were associated with an increased risk of poor fetal and neonatal outcomes. Asthma significantly increased the risk of stillbirth in underweight [adjusted RR: 2.22 (95% CI: 1.25-3.94] and obese [1.74 (1.11-2.71)]; neonatal death in underweight [3.41 (1.89-6.16)] and obese [2.22 (1.37-3.59)] and perinatal death in underweight [2.34 (1.50-3.66)] and obese [1.92 (1.38-2.67)] women. Admission to the neonatal intensive care unit was increased in neonates of underweight [1.65 (1.44-1.89)] and obese [1.26 (1.14-1.40)] asthmatic women. Conclusions Extremes of BMI, specifically underweight and obesity, increased the risk of adverse perinatal outcomes among asthmatic women highlighting the importance of accounting for BMI during pre-conception and pregnancy related management of asthmatic women.

Neonatal death is a major concern for Indigenous women with asthma during pregnancy and could be prevented with better models of care.

Asthma is the most common respiratory illness in Aboriginal and Torres Strait Islander Australians. From the Mater Mothers routinely collected perinatal data in Brisbane we have identified that 24% of Indigenous and 17% of non-Indigenous women have pregnancies complicated by asthma. Indigenous women with asthma are more likely to have poorer birth outcomes when compared to non-Indigenous women with asthma, with neonatal death being doubled in asthmatic Indigenous women. These data indicate that asthma management during pregnancy is an unmet need for Indigenous women and essential if we are to avoid these devastating outcomes for Indigenous families.

Exhaled volatilome analysis as a useful tool to discriminate asthma with other coexisting atopic diseases in women of childbearing age

The prevalence of asthma is considerably high among women of childbearing age. Most asthmatic women also often have other atopic disorders. Therefore, the differentiation between patients with atopic diseases without asthma and asthmatics with coexisting diseases is essential to avoid underdiagnosis of asthma and to design strategies to reduce symptom severity and improve quality of life of patients. Hence, we aimed for the first time to conduct an analysis of volatile organic compounds in exhaled breath of women of childbearing age as a new approach to discriminate between asthmatics with other coexisting atopic diseases and non-asthmatics (with or without atopic diseases), which could be a helpful tool for more accurate asthma detection and monitoring using a noninvasive technique in the near future. In this study, exhaled air samples of 336 women (training set (n = 211) and validation set (n = 125)) were collected and analyzed by thermal desorption coupled with gas chromatography-mass spectrometry. ASCA (ANOVA (analysis of variance) simultaneous component analysis) and LASSO + LS (least absolute shrinkage and selection operator + logistic regression) were employed for data analysis. Fifteen statistically significant models (p-value < 0.05 in permutation tests) that discriminated asthma with other coexisting atopic diseases in women of childbearing age were generated. Acetone, 2-ethyl-1-hexanol and a tetrahydroisoquinoline derivative were selected as discriminants of asthma with other coexisting atopic diseases. In addition, carbon disulfide, a tetrahydroisoquinoline derivative, 2-ethyl-1-hexanol and decane discriminated asthma disease among patients with other atopic disorders. Results of this study indicate that refined metabolomic analysis of exhaled breath allows asthma with other coexisting atopic diseases discrimination in women of reproductive age.