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":"哮喘控制、肺功能和病情恶化的性别差异：ATLANTIS 研究。","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":"<p><strong>Background: </strong>Asthma is a heterogeneous disease with a prevalence and severity that differs between male and female patients.</p><p><strong>Question: </strong>What are differences between male and female patients with asthma with regard to asthma control, lung function, inflammation and exacerbations?</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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, R<sub>5</sub>-R<sub>20</sub>: 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.</p><p><strong>Interpretation: </strong>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.</p><p><strong>Trial registration number: </strong>NCT02123667.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":null,"pages":null},"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":"{\"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\":\"<p><strong>Background: </strong>Asthma is a heterogeneous disease with a prevalence and severity that differs between male and female patients.</p><p><strong>Question: </strong>What are differences between male and female patients with asthma with regard to asthma control, lung function, inflammation and exacerbations?</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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, R<sub>5</sub>-R<sub>20</sub>: 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.</p><p><strong>Interpretation: </strong>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. 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Sex differences in asthma control, lung function and exacerbations: the ATLANTIS study.
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.
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.
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