Asthma is a complex respiratory disease that affects millions globally, with significant variability in its clinical presentation between men and women. Understanding these sex-based differences is crucial for optimizing treatment and improving patient outcomes. The ATLANTIS study offers valuable insights into how sex influences asthma control, lung function, and exacerbations. The findings of this study emphasize the need for tailored clinical approaches that consider the unique characteristics of asthma in male and female patients.
The ATLANTIS (Assessment of Small Airways Involvement in Asthma) study is an extensive observational cohort study involving 773 asthma patients across nine countries (Australia, Canada, China, France, Germany, Italy, Netherlands, Spain, UK). The primary goal was to explore sex differences in asthma control, lung function, and exacerbations, with a particular focus on small airways. Previous studies on sex differences in asthma lack extensive clinical characterisation or a broad spectrum of asthma severities and often did not take the presence and extent of small airways dysfunction (SAD) into account. The aim of this post hoc study was to include parameters of both large and small airway function.
This comprehensive approach sets ATLANTIS apart from previous research, offering a more nuanced understanding of how asthma presents differently in men and women.
The study found that women had significantly poorer asthma control compared to men. This was indicated by higher scores on the Asthma Control Questionnaire (ACQ-6), reflecting greater difficulty in symptom management. Women were also more likely to be on higher Global Initiative for Asthma (GINA) treatment steps, suggesting more severe disease that required intensive management. These differences may be influenced by hormonal factors, differences in airway inflammation, or variations in healthcare utilization.
In terms of lung function, men exhibited more severe airway obstruction, as evidenced by a lower forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio. This suggests that large airway dysfunction may play a more significant role in asthma among men. Conversely, women showed higher airway resistance, particularly in the small airways, as measured by impulse oscillometry. Small airway dysfunction, increasingly recognized as a critical component of asthma severity in women, could be linked to anatomical differences or variations in inflammatory responses.
A particularly significant finding was the higher risk of asthma exacerbations in women, independent of factors such as GINA step and blood eosinophil levels. Asthma exacerbations, characterized by acute worsening of symptoms, are a major concern due to their association with increased morbidity and healthcare costs. The study suggests that female patients may benefit from more proactive management to prevent exacerbations, including closer monitoring and potentially earlier intervention.
The findings from the ATLANTIS study have important implications for clinical practice. The observed differences in asthma control and lung function between men and women highlight the potential benefits of sex-specific treatment strategies. For instance, given the higher prevalence of small airway dysfunction in women, clinicians might consider therapies that better target these airways, such as fine-particle inhaled corticosteroids. Men, who are more prone to large airway obstruction, may benefit from strategies focusing on bronchodilation.
The increased risk of exacerbations in women calls for a more aggressive management approach. This could involve more frequent lung function monitoring, earlier intervention during symptom worsening, and enhanced patient education on treatment adherence. By personalizing asthma management based on sex-specific characteristics, healthcare providers can improve disease control and reduce the frequency of exacerbations.
The ATLANTIS study highlights critical sex differences in asthma that should be considered in clinical practice. By adopting sex-specific management strategies, clinicians can better tailor treatments to individual patient needs, ultimately improving outcomes for those with asthma.