Women Hospitalized For Asthma More Often Than Men

Women with acute asthma who have been treated in the emergency department (ED) are 60% more likely than men treated in the ED to require hospitalization, according to a new study.

A team led by Rose Chasm, MD, FAAEM, FACEP, FAAP, assistant professor in the department of emergency medicine at the University of Maryland School of Medicine, analyzed sex differences in patient characteristics as well as hospitalization risks in 2,000 ED patients with acute asthma.
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According to Chasm and colleagues, many of the male and female patients studied had certain factors in common. For example, most had not been seen by an allergist, and had not used controller medications such as inhaled corticosteroids for their asthma. Many were also overweight, and some were active smokers, the authors noted, adding that a high percentage did not have health insurance. After adjusting for these variables, the researchers found that women were still 60% more likely to be hospitalized after a trip to the ED for acute asthma, in comparison to men.

The authors point out that chronic asthma was an issue in many patients. For instance, 13% of female participants had at some time been intubated for asthma, with 36% of women and 32% of the men having been hospitalized for asthma. In addition, 16% of women and 13% of men had been hospitalized due to asthma within the past 12 months.

There may be a number of reasons for these findings, including altered perception of airflow obstruction, potential influences of female sex hormones, differences in bronchial hyper responsiveness, and health behaviors, according to the authors, who stress that more research is needed to determine the exact reasons for this disparity.

The team’s findings “emphasize 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,” says Chasm.

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 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,” she says.

While asthma is a chronic disease with no known cure, “it can be controlled when managed properly,” adds Chasm.

“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 every suffering severe exacerbations, especially women.”

—Mark McGraw

Reference

Chasm R, Pei V, et al. Sex differences in risk of hospitalization among emergency department patients with acute asthma. Annals of Allergy, Asthma and Immunology. 2015.