Studies of disease trends in the United States show distinct patterns for asthma in women, yet our understanding of specific causes is limited. Greater awareness of this issue and further research will help us customize diagnosis and treatment of asthma in women. Here's what we know:

1. Asthma is more common in women than men after late childhood. Young boys have a higher rate of asthma than young girls. But some time around adolescence, the balance shifts over to girls and stays there. By middle age, women with asthma outnumber men almost 2 to 1.


2. Asthma hospitalization and death rates are higher in women than men. These statistics are due in part to the higher incidence of asthma in women (see point #1), but may also be related to hormones (see point #5) and other factors.


3. Obesity is a risk factor for asthma in women. Adult women with a higher body mass inde? (BMI, body weight adjusted for height) have a higher incidence of asthma than other women. The effect of obesity on asthma does not appear to be as important for men. One study showed that girls who became obese as pre-adolescents had a higher incidence of wheezing and asthma later in childhood than non-obese girls. This is an important counseling point for patients and another reason to ensure good health habits in children!


4. Women with asthma may be at higher risk from the effects of smoking than men. Comparison studies of women and men smokers show that women have a higher risk of developing asthma. Clearly smoking and second-hand smoke are risks for developing asthma 01 worsening asthma symptoms for anyone, but it appears that this risk is even higher for women smokers. In addition, children whose mothers smoke have a much higher incidence of allergies. asthma and respiratory tract infections (throat, ears, sinuses, lungs). Children bom to smoking mothers have a lower birth weight as well.


5. Twenty to forty percent of women experience worsening of asthma symptoms during their menstrual periods, which could lead to emergency room visits and life-threatening episodes. The exact reasons for this are unclear, but it may be due to falling hormone levels during that phase of the menstrual cycle. Keep a daily symptom diary to help you track trends in your asthma symptoms and talk to your doctor about medication strategies during this time. Using a peak flow meter on a regular basis will help correlate asthma symptoms with actual breathing flow rates, and therefore allow for more accurate prescribing of your asthma medication(s).


6. Asthma is one of the most common conditions affecting pregnancy. Four to eight percent of pregnant women in the United States are affected by asthma. But asthma can be managed effectively for the best outcome for mothers and babies.


7. Asthma severity can improve, worsen or remain unchanged during pregnancy. Patients with severe asthma are particularly likely to experience worsening asthma symptoms during pregnancy, but the effect of pregnancy on asthma symptoms is unpredictable. Asthma should be followed especially closely during pregnancy, and asthma treatment should be customized to each patient.


8. Women often stop using asthma medications during pregnancy. Pregnant women are often concerned about the effect of asthma medications on a fetus and may stop taking or reduce their medications. Inadequate control of asthma is associated with adverse maternal and fetal outcomes.


9. The risk to the mother and fetus of uncontrolled asthma during pregnancy is far greatci than the risk of using asthma medications, including inhaled corticosteroids. The goal is to use medications to keep asthma stable by preventing airway inflammation and treating bronchospasm (wheeze and cough spasm) when symptoms first appear.

   All pregnant women should have a peak flow meter and use it regularly during their pregnancy. Pregnant asthmatic women should also remember that their unborn child is much more sensitive to changes in the mother's blood oxygen level. (Hemoglobin is the protein structure in the red blood cell that is responsible for carrying oxygen from your lungs to all other organs. Because the fetus must get its oxygen from the mother through the umbilical cord, fetal hemoglobin is very sensitive to small changes in the mother's blood oxygen levels. It is therefore imperative that the pregnant asthmatic maintain a normal oxygen level as much as possible.)

   Be sure to talk to either Dr. Tulin-Silver or Dr. Kinhal when you first leam that you are pregnant AANMA's "Breathing for Two" brochure also offers support, including information on managing asthma during pregnancy, labor and delivery. Call 800-878-4403 to order your free copy.



10. National guidelines for treating asthma should be followed in women of childbearing age and during pregnancy. Get a copy of the National Asthma Education and Prevention Program's Guidelines for the Diagnosis and Management of Asthma online at www.nhlbi.nih.gov/guidelines/asthma Drs. Tulin-Silver and Kinhal will be happy to review these guidelines with you.

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Michigan Allergy, Sinus & Asthma Specialists

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