Sex differences in asthma control, lung function and exacerbations: the ATLANTIS study.

IF 3.6 3区医学 Q1 RESPIRATORY SYSTEM

BMJ Open Respiratory Research Pub Date : 2024-06-19 DOI:10.1136/bmjresp-2024-002316

Tessa M Kole, Susan Muiser, Monica Kraft, Salman Siddiqui, Leonardo M Fabbri, Klaus F Rabe, Alberto Papi, Chris Brightling, Dave Singh, Thys van der Molen, Martijn C Nawijn, Huib A M Kerstjens, Maarten van den Berge

{"title":"Sex differences in asthma control, lung function and exacerbations: the ATLANTIS study.","authors":"Tessa M Kole, Susan Muiser, Monica Kraft, Salman Siddiqui, Leonardo M Fabbri, Klaus F Rabe, Alberto Papi, Chris Brightling, Dave Singh, Thys van der Molen, Martijn C Nawijn, Huib A M Kerstjens, Maarten van den Berge","doi":"10.1136/bmjresp-2024-002316","DOIUrl":null,"url":null,"abstract":"Background: Asthma is a heterogeneous disease with a prevalence and severity that differs between male and female patients.Question: What are differences between male and female patients with asthma with regard to asthma control, lung function, inflammation and exacerbations?Methods: We performed a post hoc analysis in the ATLANTIS (Assessment of Small Airways Involvement in Asthma) study, an observational cohort study including patients with asthma from nine countries with a follow-up of 1 year during which patients were characterised with measures of large and small airway function, questionnaires, inflammation and imaging. We compared differences in baseline characteristics and longitudinal outcomes between male and female patients with asthma.Results: 773 patients were enrolled; 450 (58%) of these were female. At baseline, female patients with asthma were in higher Global Initiative for Asthma (GINA) steps (p=0.042), had higher Asthma Control Questionnaire 6 (F: 0.83; M: 0.66, p<0.001) and higher airway resistance as reflected by uncorrected impulse oscillometry outcomes (ie, R5-R20: F: 0.06; M: 0.04 kPa/L/s, p=0.002). Male patients with asthma had more severe airway obstruction (forced expiratory volume in 1 s/forced vital capacity % predicted: F: 91.95; M: 88.33%, p<0.01) and more frequently had persistent airflow limitation (F: 27%; M: 39%, p<0.001). Blood neutrophils were significantly higher in female patients (p=0.014). With Cox regression analysis, female sex was an independent predictor for exacerbations.Interpretation: We demonstrate that female patients are in higher GINA steps, exhibit worse disease control, experience more exacerbations and demonstrate higher airway resistance compared with male patients. The higher exacerbation risk was independent of GINA step and blood eosinophil level. Male patients, in turn, have a higher prevalence of persistent airflow limitation and more severe airflow obstruction. These findings show sex can affect clinical phenotyping and outcomes in asthma.Trial registration number: NCT02123667.","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"11 1","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11191767/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Open Respiratory Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjresp-2024-002316","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Asthma is a heterogeneous disease with a prevalence and severity that differs between male and female patients.

Question: What are differences between male and female patients with asthma with regard to asthma control, lung function, inflammation and exacerbations?

Methods: We performed a post hoc analysis in the ATLANTIS (Assessment of Small Airways Involvement in Asthma) study, an observational cohort study including patients with asthma from nine countries with a follow-up of 1 year during which patients were characterised with measures of large and small airway function, questionnaires, inflammation and imaging. We compared differences in baseline characteristics and longitudinal outcomes between male and female patients with asthma.

Results: 773 patients were enrolled; 450 (58%) of these were female. At baseline, female patients with asthma were in higher Global Initiative for Asthma (GINA) steps (p=0.042), had higher Asthma Control Questionnaire 6 (F: 0.83; M: 0.66, p<0.001) and higher airway resistance as reflected by uncorrected impulse oscillometry outcomes (ie, R₅-R₂₀: F: 0.06; M: 0.04 kPa/L/s, p=0.002). Male patients with asthma had more severe airway obstruction (forced expiratory volume in 1 s/forced vital capacity % predicted: F: 91.95; M: 88.33%, p<0.01) and more frequently had persistent airflow limitation (F: 27%; M: 39%, p<0.001). Blood neutrophils were significantly higher in female patients (p=0.014). With Cox regression analysis, female sex was an independent predictor for exacerbations.

Interpretation: We demonstrate that female patients are in higher GINA steps, exhibit worse disease control, experience more exacerbations and demonstrate higher airway resistance compared with male patients. The higher exacerbation risk was independent of GINA step and blood eosinophil level. Male patients, in turn, have a higher prevalence of persistent airflow limitation and more severe airflow obstruction. These findings show sex can affect clinical phenotyping and outcomes in asthma.

Trial registration number: NCT02123667.

查看原文本刊更多论文

哮喘控制、肺功能和病情恶化的性别差异：ATLANTIS 研究。

背景：哮喘是一种异质性疾病，其发病率和严重程度在男性和女性患者之间存在差异：哮喘男女患者在哮喘控制、肺功能、炎症和病情加重方面有何差异？我们在 ATLANTIS（哮喘小气道受累评估）研究中进行了一项事后分析，该研究是一项观察性队列研究，包括来自 9 个国家的哮喘患者，随访时间为 1 年，在此期间通过测量大气道和小气道功能、问卷调查、炎症和影像学检查了解患者的特征。我们比较了男性和女性哮喘患者在基线特征和纵向结果方面的差异：共登记了 773 名患者，其中 450 人（58%）为女性。基线时，女性哮喘患者的哮喘全球倡议（GINA）级别较高（P=0.042），哮喘控制问卷 6（女：0.83；男：0.66，P5-R20：女：0.06；男：0.04 kPa/L/s，P=0.002）。男性哮喘患者的气道阻塞更为严重（1 秒钟用力呼气量/用力生命容量预测值%：女：91.95；男：88.33%，p解释：我们的研究表明，与男性患者相比，女性患者的 GINA 级数更高，疾病控制能力更差，病情加重的次数更多，气道阻力更大。较高的病情恶化风险与 GINA 级数和血液中的嗜酸性粒细胞水平无关。而男性患者的持续气流受限发生率更高，气流阻塞也更严重。这些研究结果表明，性别会影响哮喘的临床表型和治疗效果：NCT02123667.

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

BMJ Open Respiratory Research RESPIRATORY SYSTEM-

CiteScore

6.60

自引率

2.40%

发文量

审稿时长

12 weeks

期刊介绍： BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.