Table of Contents
Asthma: St John Ambulance explain how to help during attack
Research into the relationship between sex hormones and asthma could unlock better treatments for millions of women, experts say.
The debilitating lung condition is more common among women, who are three times more likely to be admitted to hospital and almost twice as likely to die from an asthma attack than men.
Yet for decades, crucial differences between male and female biology have been overlooked during the hunt for drugs.
Asthma + Lung UK is supporting trailblazing female scientists who are determined to close the gap and calling for more research to address these inequalities.
The charity’s director of research and innovation, Dr Samantha Walker, said too many clinical trials assumed that men and women respond to medications in the same way.
She added: “Female sex hormones, just like pollen, air pollution and dust can make asthma symptoms worse or even trigger an attack.
“To prevent this from happening, it’s important to understand why this is and what treatments, new and existing, will be the most effective for women of all ages.”
Women are three times more likely to be admitted to hospital with asthma than men
Professor Mona Bafadhel, the charity’s chair of women and asthma research, is among those scientists working to address gaps in understanding.
She is investigating how oestrogen effects elastin and collagen, the proteins that give all cells in our body shape and structure.
Her work at King’s College London focuses on people whose asthma inflames tiny air sacs in their lungs, making it harder for oxygen to get into the bloodstream.
Prof Bafadhel said: “I’m also interested in determining whether changes in the tiny air sacs in our lungs can be anticipated using non-invasive skin assessments for some people.
“For example, just by examining someone’s skin on their body could reveal how their asthma is behaving and may be able to inform their treatment.”
Prof Bafadhel said the UK has “some of the most comprehensive health data in the world at its fingertips”, but we still do not know anywhere near enough about how sex hormones and their influence on asthma.
She added: “There is not enough research into why women are more likely to be hospitalised and die from asthma and what treatments new and existing, could help women.
“The UK has a great opportunity to become a global leader in research on the link between sex hormones and asthma, which would benefit millions of women.”
Dr Hannah Durrington, a consultant in respiratory medicine working at the University of Manchester, is studying how asthma is affected by the body clock.
Studies have shown that the results of tests for asthma can vary depending on what time of day they are administered.
One of her projects examines why female night shift workers are more at risk of asthma than male staff, while another is investigating whether treatments such as inhalers are more effective when taken in the morning or afternoon.
Dr Durrington said: “Since asthma is more common and more severe in women, we are looking to see if sex differences in our body clocks might be responsible for the increased risk of asthma in women.
“Simply changing the time of day at which asthma treatments are taken to improve their effectiveness would be a low-cost and easy way of improving asthma management in the here and now.
“Ultimately new therapies targeting the body clock might unlock exciting ways of treating asthma in the future.”
Better understanding the mechanisms driving asthma in women could lead to more tailored treatments, preventing patients being put on high-dose oral steroids which can cause side effects including osteoporosis and depression.
Asthma + Lung UK is campaigning for more research into the sex-related differences in asthma and support from study funders to address inequalities.
Dr Walker said the “holy grail” would be starting to reverse the trend so women can better manage their condition or take new drugs to reduce their risk of serious complications.
She added: “It’s encouraging that people are starting to see this as an issue and think about how we might do something about it.
“We just need a lot more investment in this area to try and work it out.”
Poppy Hadkinson ended up in hospital repeatedly due to severe asthma
'My hormone cycle wreaked havoc on my breathing'
Poppy Hadkinson’s hormones had such a terrible effect on her asthma that she feared she would end up in hospital every month.
She was diagnosed at the age of 11 and her symptoms became “pretty much impossible to control” in her teens.
Poppy, now 30, said: “It was my mum who first noticed a clear link between a worsening of my asthma symptoms and my periods
“She started to keep a diary as evidence that my menstrual cycle was playing havoc with my breathing.”
Despite taking steroids, Poppy suffered regular asthma attacks in the run up to her period. She ended up in a coma and needing ventilation on four occasions.
Finally, she was offered a drug called Omalizumab nine years ago. Poppy said: “It has been an absolute game-changer for me, and I haven’t been hospitalised since I started receiving monthly injections of the medication at the age of 21.
“I have been lucky, but my heart still goes out to all those other women who dread every hormonal change (periods, pregnancy and perimenopause) for fear that they will experience a life-threatening asthma attack.
“We need much more research into the sex-related differences with asthma. Without this, more women with asthma run the risk of living as I was – in constant limbo, and too terrified to live their lives.”
It has been an ongoing problem that women of child-bearing age are often left out of medical research into new treatments.
While things have been moving in the right direction, many clinical trials still don’t specifically and routinely analyse results by biological sex, which is a significant problem.
This assumption that men and women respond similarly to asthma drugs is hampering progress and has led to a more limited understanding of how drugs may work differently, or at all, in women compared to men.
When considering the impact of asthma on women, we know women are more likely to have asthma, are three times more likely to be admitted to hospital and are almost twice as likely to die from an asthma attack.
This is because female sex hormones, just like pollen, air pollution and dust can make asthma symptoms worse or even trigger an attack.
To prevent this from happening, it’s important to understand why this is and what treatments, new and existing, will be the most effective for women of all ages.
Evidence shows many women experience changes in their asthma symptoms, including wheezing and breathlessness at key moments of hormonal change, such as during puberty, periods, pregnancy and menopause.
But the problem is not enough research has been done to explore the relationship between sex hormones and asthma.
This is why the charity is determined to change this and is investing in its own women with asthma research programme. But we can’t do this alone and need the support of other funders.
It’s also clear any research conducted will need to address the sex-based inequalities, to understand why asthma is worse for women and what new and existing treatments will be most effective for them.
This lack of research is also part of a wider problem within lung health. Although lung conditions are the third biggest killer in the UK, they only receive two percent of public investment in research that would help diagnose, treat and manage them much more effectively.
We have barely scratched the surface when it comes to understanding lung conditions and with greater investment we can save and transform millions of lives.
- Dr Samantha Walker is Director of Research and Innovation at Asthma + Lung UK