Women hospitalized more for asthma than men

June 18, 2015

A new study notes that while men and women have similar risk factors for asthma flare-ups, the latter are hospitalized at a greater rate.

Women are more likely than men to need hospitalization after seeking emergency department (ED) treatment for an asthma attack, according to a study published recently in the Annals of Allergy, Asthma and Immunology.

According to the National Institute of Allergy and Infectious Diseases, the number of people with asthma continues to grow. One in 12 people (about 25 million, or 8% of the population) had asthma in 2009, compared with 1 in 14 (about 20 million, or 7%) in 2001. Women were more likely than men to have asthma.

ChasmRose Chasm, MD, a clinical assistant professor of emergency medicine at the University of Maryland's School of Medicine in Baltimore, and colleagues analyzed the likelihood that 2,000 patients treated in the ER for asthma would need to be admitted to the hospital. Although the men and women had similar risk factors for a flare-up of their condition, women were still 60% more likely to be hospitalized.

Just 10% of the women in this study had been seen by an allergist in the last year.

Related:Study: Weight loss key to managing asthma in obese adults

Chasm and researchers found that many of the ED patients had poorly controlled chronic asthma. Of the women, 13% had been intubated at some point, 36% had been hospitalized before for asthma and 16% had been admitted within the past year. In comparison, 12% of men had been intubated in the past, 32% had been hospitalized for asthma and 13% had been admitted in the past year.

"These findings demonstrate the inadequacy of current clinical and public health measures to manage female patients with asthma,” Chasm tells Medical Economics. “The gender difference is probably related to the effects of female sex hormones, to gender-specific health behaviors, to perceived differences in the severity of troubled breathing, and to differences in bronchial hyperactivity and resulting airway obstruction.”

More evidence-based studies are needed to pinpoint the causes of the sex-based differences that the study showed, she adds.

The study also emphasized the importance of an aggressive treatment plan that provides optimal pharmocotherapy along with close, frequent follow-up for all asthma patients, but especially for female patients whom are at a higher risk for severe exacerbations and for hospitalization, according to Chasm.

“We tend to focus on the treatment of acute exacerbations, but long-term management is just as, if not more, important,” she says. “Our report should encourage primary-care providers to be more assertive in advocating lifestyle changes that reduce or eliminate risk factors for asthma and its exacerbations, such as smoking cessation and weight loss while avoiding known triggers such as environmental and chemical allergens.

“Depending on the primary-care provider's comfort level and competency in managing asthma, the treatment plan should include referral to a specialist such as a pulmonologist or allergist, particularly for those with severe disease, to ensure that their management is maximized with the most appropriate preventative medications and possibly needed testing such as pulmonary function testing and allergen testing is completed,” Chasm says. “Finally, physicians should, in particular, be keenly monitoring their female patients with asthma.”

Asthma is a chronic disease with no known cure, but it can be controlled when managed properly, Chasm says.

“Despite this knowledge and the development of preventative medications, the incidence of asthma diagnoses and exacerbations continue to rise at an alarming rate,” she says. “Asthma-related costs are huge. In addition to the obvious medical costs and the financial impact of missed days from work, it diminishes patients' quality of life by, for example, causing them to miss school days and even poses the risk of early death.  Our goal is to prevent patients with asthma from ever suffering severe exacerbations in the first place, especially women who are at high risk for severe disease and hospitalization.”