Asthma Still Targets Women


Vol. 16 •Issue 19 • Page 14
Asthma Still Targets Women

A quick Internet search under the key words “women’s health” returns thousands of hits with the latest research findings into breast cancer, reproductive health and heart disease. While these topics continue to lead the pack of prevalent health concerns, one disorder—asthma—continues to afflict an increasing number of adult women.

Nearly 17 million Americans have been diagnosed as asthmatics, but the alarming finding, according to researchers, is asthma’s overwhelming favoritism toward women. The Centers for Disease Control and Prevention reports that a survey of U.S. doctors found that 9 percent of adult women have asthma while only 5 percent of adult men do.

The number of adult female asthmatics is climbing, rising from 6.5 million in 1997 to 7.1 million in 2001, according to the American Lung Association’s Epidemiology and Statistics Unit. The number of male asthmatics is climbing, too, but not at the same rate, growing from 4.6 million men in 1997 to 4.9 million in 2001. Further statistics from the ALA reveal that in 2000, a total of 2,855 women died from asthma as did 1,632 American men.

Why does asthma continue to prefer women? Or could doctors just be hearing about complications more from women? Asthma and immunology specialists say it could be a little of both.

No study has clearly defined the reason for the gender difference, but hormones and the menstrual cycle could be connected to airway inflammation, said Marianne Frieri, PhD, MD, director of allergy and immunology at Nassau University Medical Center in East Meadow, N.Y. Namely, the hormonal change right before and during menstruation may cause a woman’s airways to constrict.

“The uterus has a number of allergy cells that may be induced by estrogen and progesterone,” she said. “If you combine the effects of estradiol progesterone it can induce the granulation of these cells, meaning they open up their mediators and can cause problems.”

CHANGING HABITS

Biology aside, some researchers are pointing to a disparity of habits between the genders. Where people work and how they pass the time may contribute to the greater number of female asthmatics.

“Women generally are home more,” Frieri said. “They are exposed to indoor allergens especially animal dander and dust mites. Many women are housekeepers, and occupationally, there may be a greater exposure for household cleaners. We know that genes can control asthma, but occupation and habits definitely do play into it.”

Susan C. Ristow, MD, co-medical director of Mary Parkes Asthma Center in Rochester, N.Y., said the increase in the number of women smokers today compared to decades ago may produce more women filling the seats in the waiting rooms of asthma specialists.

“Increased cigarette smoking is definitely a factor,” she said. “When women have asthma and they are non-smokers, it may be something mild, something that acts up during exercise or certain seasons. But when you already have inflamed airways and you smoke, it’s like pouring acid on a burn and it makes the asthma harder to control.”

Bronchodilators and anti-inflammatory drugs remain the most common medications used to treat asthma in both women and men, Ristow said. However, when a woman becomes pregnant, she needs to take precautions as to what medications she takes. Especially during gestation, mothers-to-be should remain adamant about treating asthma aggressively, she added.

“The vast majority of medications pregnant women take for treating asthma are safe, but we always do have to have a special level of concern regarding some of the newer medications that have not been used during pregnancy. There’s a certain subset, some older medications like prednisone, that we feel are safe,” Ristow explained.

Managing asthma becomes more difficult in older women. The CDC reports that medicines for conditions such as high blood pressure can aggravate asthma, and some asthma medicines can complicate heart conditions and osteoporosis.

CONTACT A SPECIALIST

When women become pregnant, they need to see an asthma specialist for clinical advice because there is no universal way asthma reacts. “Asthma in pregnancy brings about the rule of three: one-third gets better; one-third gets worse; and a third stay the same. That’s generally true,” Frieri said.

The rule of threes does not apply equally to women who have allergies during the nine months of gestation. Allergies likely will exacerbate during pregnancy, but not necessarily asthma.

“Pregnancy makes the nose worse,” Frieri said. “So nasal allergies are affected by pregnancy. Thyroid disease can also affect the nose, as well as the skin. If they have underlying thyroid and are pregnant, they can have nasal congestion. That could be a problem because they really can’t breathe as well.”

Gender discrimination in adults is particularly limited to asthma, while nasal allergies continue to affect men and women about equally, Ristow said.

While researchers continue trying to pinpoint why asthma impinges on women more, Ristow said what matters in identifying asthma and allergies in people is more a matter of genetics than gender.

If the rest of the family has nose allergies, chances are likely that the person across the family dining room table is going to have nose allergy and not asthma. “If there’s been a family history of asthma as well as allergy, it’s much more likely the individual will have asthma,” noted Ristow.

TAKING A HIT

A 2000 CDC survey found that 25 percent of adult men and about 21 percent of adult women in the United States were smokers. On a global scale, however, the World Health Organization recently discovered the line between the number of male and female tobacco users is thinning. That news has some health officials worried that projected tobacco deaths for the future may be underestimated.

While American men may be lighting up more, it is the women who are seeing more negative impacts to their health.

Lung cancer is more prevalent in female smokers than in male smokers because women are more predisposed to the carcinogens in cigarettes, according to the Society for Women’s Health Research. Furthermore the American Cancer Society reports that women who smoke heavily are nearly three times as likely to develop bronchitis or emphysema, and nearly 75 percent are more likely to have chronic sinus infections.

It is not just their respiratory systems that are seeing the effects of tar and nicotine. It is also influencing their reproductive health and their children’s health.

Women who smoke have more trouble getting pregnant and are susceptible for primary and secondary infertility, according to a CDC news release. The American Cancer Society also estimates that U.S. mothers who smoke half a pack daily cause up to 26,000 new cases of asthma in children annually.

Given the endless data on the negative impact on women smokers, a lot of women cite another health concern, weight gain, for not kicking the habit. Research shows the average weight gain after quitting smoking is only about 5 pounds, which can be controlled through diet and exercise, the cancer society found.

You can reach Stacey Miller at smiller@merion.com.

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