Women hospitalized for asthma are more likely to be readmitted within 30 and 90 days compared with men, while female patients with chronic obstructive pulmonary disease receive more in-hospital interventions and have lower odds of readmission within 90 days and lower mortality rates.

Led by Hannah Whittaker et al., and published in BMJ Open Respiratory Research, researchers analyzed data from the National Asthma and COPD Audit Programme during 2019-2020, examining 16,370 adults with asthma, 7,156 children and young people with asthma, and 28,354 adults with COPD. The study investigated in-hospital management, readmission rates, and mortality outcomes by linking hospital records with national mortality data.

Findings showed that adult women with asthma had a 22% higher risk of readmission within 30 days (adjusted odds ratio [aOR] 1.22) and 34% higher risk within 90 days (aOR 1.34) compared with men, despite receiving similar in-hospital treatment. Among children and young people, females also faced higher readmission rates than males. Researchers suggested that factors such as primary care access, medication adherence, or hormonal differences might contribute to this disparity.

For COPD patients, women were more likely than men to receive respiratory specialist reviews (10% higher odds), non-invasive ventilation (18% higher odds), and discharge bundles (7% higher odds). Female COPD patients also had lower odds of 90-day readmission and mortality. These differences may reflect variations in disease presentation, as previous studies indicate that women with COPD tend to have more severe symptoms despite better lung function and fewer years of smoking exposure than men.

"For asthma, factors other than in-hospital management are contributing towards higher hospital admissions in females. This might include management within primary care, steroid responsiveness or hormonal differences," said Whittaker of Imperial College London's School of Public Health.

Limitations of the study included missing lung function data, lack of medication and hospitalization history, and the exclusion of transgender and nonbinary patients due to sample size constraints. Importantly, COPD analyses were not adjusted for disease severity, which could affect interpretation of the results. Pediatric asthma mortality was also not analyzed.

Despite these gaps, the study highlights observed associations between sex and respiratory disease outcomes. While in-hospital asthma care appeared similar between sexes, external factors may contribute to higher readmission rates in women. The findings also prompt further investigation into whether differences in hospital care are associated with the observed survival advantage in women with COPD. Future research should examine primary care management, hormonal influences, and potential gender-related differences in treatment.

Conflict of interest disclosures can be found in the study.