Female patients with asthma were found to have worse disease control, higher airway resistance, and a greater risk of exacerbations compared to male patients, according to a post-hoc analysis of the ATLANTIS (Assessment of Small Airways Involvement in Asthma) study.

The one-year observational study investigated sex-related differences in asthma control, lung function, and exacerbations in 773 patients from nine countries, with 450 female patients (58%). Results indicated that female patients were in higher Global Initiative for Asthma (GINA) steps (p=0.042), had worse asthma control, and experienced a higher risk of exacerbations compared to males. The mean Asthma Control Questionnaire score was higher in females (0.83 vs. 0.66 in males, p<0.001), and quality of life scores measured by the Mini Asthma Quality of Life Questionnaire were significantly lower in female patients (p<0.001). Females also exhibited greater airway resistance, as indicated by impulse oscillometry (R5-R20: 0.06 vs. 0.04 kPa/L/s, p=0.002).

Male patients, who were more likely to have early-onset asthma (44% vs. 35%, p=0.017), showed more severe airway obstruction, with a lower forced expiratory volume in 1 second/forced vital capacity ratio (88.33% vs. 91.95% in females, p<0.01) and a higher prevalence of persistent airflow limitation (39% vs. 27%, p<0.001). While female patients had significantly higher blood neutrophil levels (p=0.014), male patients demonstrated more severe obstruction in airways.

Cox regression analysis identified female sex as an independent risk factor for exacerbations, regardless of GINA step or blood eosinophil levels. The findings, published in BMJ Open Respiratory Research, indicate that sex can significantly affect clinical phenotyping and outcomes in asthma.

Full disclosures can be found in the published study.