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Asthma
Original research
Impact of sex on severe asthma: a cross-sectional retrospective analysis of UK primary and specialist care
  1. Lola Loewenthal1,2,
  2. John Busby3,
  3. Ronald McDowell4,5,
  4. Thomas Brown6,
  5. Hassan Burhan7,
  6. Rekha Chaudhuri8,9,
  7. Paddy Dennison10,
  8. James William Dodd11,12,
  9. Simon Doe13,
  10. Shoaib Faruqi14,
  11. Robin Gore15,
  12. Elfatih Idris16,
  13. David Joshua Jackson17,18,
  14. Mitesh Patel19,
  15. Thomas Pantin20,
  16. Ian Pavord21,
  17. Paul E Pfeffer22,
  18. David B Price23,24,
  19. Hitasha Rupani25,26,
  20. Salman Siddiqui1,
  21. Liam G Heaney27,
  22. Andrew Menzies-Gow28
  23. On behalf of the UK Severe Asthma Registry
  1. 1 National Lung and Heart Institute, Imperial College London, London, UK
  2. 2 Department of Asthma and Allergy, Department of Respiratory Medicine, Royal Brompton and Harefield Hospitals, London, UK
  3. 3 Centre for Public Health, Queen's University Belfast School of Medicine Dentistry and Biomedical Sciences, Belfast, UK
  4. 4 Queen's University Belfast, Belfast, UK
  5. 5 Ulster University, Coleraine, UK
  6. 6 Respiratory Medicine, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
  7. 7 Respiratory Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
  8. 8 Respiratory Medicine, Gartnavel General Hospital, Glasgow, UK
  9. 9 University of Glasgow, Glasgow, UK
  10. 10 Southampton NIHR Respiratory Biomedical Research Unit, Southampton University Hospitals NHS Trust, Southampton, UK
  11. 11 Academic Respiratory Unit, University of Bristol, Bristol, UK
  12. 12 North Bristol Lung Centre, North Bristol NHS Trust, Westbury on Trym, UK
  13. 13 Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
  14. 14 Hull University Teaching Hospitals NHS Trust, Hull, UK
  15. 15 Addenbrooke's Hospital, Cambridge, UK
  16. 16 Royal Stoke University Hospital, Stoke-on-Trent, UK
  17. 17 Guy's Severe Asthma Centre, Guy's and St Thomas' Hospitals NHS Trust, London, UK
  18. 18 Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London Faculty of Life Sciences and Medicine, London, UK
  19. 19 University Hospitals Plymouth, University Hospitals Plymouth NHS Trust, Plymouth, UK
  20. 20 Respiratory Medicine, Manchester University NHS Foundation Trust, Manchester, UK
  21. 21 NIHR Respiratory BRC, Nuffield Department of Medicine, Oxford University, Oxford, UK
  22. 22 St Bartholomew's Hospital, London, UK
  23. 23 Observational and Pragmatic Research Institute Pte Ltd, Singapore
  24. 24 Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
  25. 25 University Hospital Southampton NHS Foundation Trust, Southampton, UK
  26. 26 University of Southampton, Southampton, UK
  27. 27 Centre of Infection and Immunity, Queen's University Belfast, Belfast, UK
  28. 28 Royal Brompton and Harefield Hospitals, London, UK
  1. Correspondence to Dr Andrew Menzies-Gow, Royal Brompton and Harefield Hospitals, London, SW3 6NP, UK; a.menzies-gow{at}rbht.nhs.uk

Abstract

Introduction After puberty, females are more likely to develop asthma and in a more severe form than males. The associations between asthma and sex are complex with multiple intrinsic and external factors.

Aim To evaluate the sex differences in the characteristics and treatment of patients with severe asthma (SA) in a real-world setting.

Methods Demographic, clinical and treatment characteristics for patients with SA in the UK Severe Asthma Registry (UKSAR) and Optimum Patient Care Research Database (OPCRD) were retrospectively analysed by sex using univariable and multivariable logistic regression analyses adjusted for year, age and hospital/practice.

Results 3679 (60.9% female) patients from UKSAR and 18 369 patients (67.9% female) from OPCRD with SA were included. Females were more likely to be symptomatic with increased Asthma Control Questionnaire-6 (UKSAR adjusted OR (aOR) 1.14, 95% CI 1.09 to 1.18) and Royal College of Physicians-3 Question scores (OPCRD aOR 1.29, 95% CI 1.13 to 1.47). However, they had a higher forced expiratory volume in 1 second per cent (FEV1%) predicted (UKSAR 68.7% vs 64.8%, p<0.001) with no significant difference in peak expiratory flow. Type 2 biomarkers IgE (UKSAR 129 IU/mL vs 208 IU/mL, p<0.001) and FeNO (UKSAR 36ppb vs 46ppb, p<0.001) were lower in females with no significant difference in blood eosinophils or biological therapy. Females were less likely to be on maintenance oral corticosteroids (UKSAR aOR 0.86, 95% CI 0.75 to 0.99) but more likely to be obese (UKSAR aOR 1.67, 95% CI 145 to 1.93; OPCRD SA aOR 1.46, 95% CI 1.34 to 1.58).

Conclusions Females had increased symptoms and were more likely to be obese despite higher FEV1% predicted and lower type 2 biomarkers with consistent and clinically important differences across both datasets.

  • Asthma
  • Asthma Epidemiology
  • Asthma in primary care

Data availability statement

Data are available on reasonable request. No data are available. Although public access to the dataset is not granted, researchers can request access for OPCRD data through the OPCRD website or by contacting info@opcrd.co.uk.

https://doi.org/10.1136/thorax-2023-220512

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    Data availability statement

    Data are available on reasonable request. No data are available. Although public access to the dataset is not granted, researchers can request access for OPCRD data through the OPCRD website or by contacting info@opcrd.co.uk.

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    Footnotes

    • X @lolaloewenthal, @theotherdodd, @OPRI_SG

    • Collaborators On behalf of the UK Severe Asthma Registry.

      The UKSAR wishes to acknowledge the help and expertise of the following individuals and groups without whom the study would not have been possible: The Academic Respiratory Unit, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol: Daniel Higbee, Caitlin Morgan, George Nava, John O’Brien, Rahul Shrimanker. Belfast Health & Social Care Trust, Belfast: Claire Butler, Nuala McCullough, Joan Sweeney. Derriford Hospital, Plymouth: Kaylee Bawler, Beverley Castell, Gemma Hayes, Mickey Symes, Charlotte Wells, Jane Willis-Chan. Gartnavel General Hospital and University of Glasgow, Glasgow: Jennifer Logan, Julie Nixon, Diane Slater. Glenfield Hospital, University Hospitals of Leicester, Leicester: Clare Boddy. Guy’s Severe Asthma Centre, King’s Centre for Lung Health, King’s College London, London: Jaideep Dhariwal, Jodie Lam, Alexandra Nanzer, Cris Roxas. Hull University Teaching Hospitals NHS Trust, Hull: Helena Cumming, Jackie Fergusson. The Newcastle upon Tyne Hospitals NHS FT, Newcastle Upon Tyne: Catherine Smith. NIHR Respiratory BRC, Nuffield Department of Medicine, University of Oxford, Oxford: Katie Borg, Clare Connelly. Observational and Pragmatic Research Institute, Singapore: Derek Skinner. Portsmouth Hospitals University NHS Trust, Portsmouth: Kate Harbour, Rachel Harvey, Laura Wiffen. Royal Brompton Hospital, London: Irene Berrar-Torre, Pujan Patel, Rachel Stead. Royal Free Hospital, London: Simon Brill, James Brown. Royal Liverpool Hospital, Liverpool: Rachel Burton, Livingstone Chishimba, Gareth Jones, Hannah Joplin, Laura Root, Seher Zaidi. Royal Stoke University Hospital, Stoke: Angela Cooper, Alison Ellis, Princy Kallukalam, Alison Scale. St Bartholomew’s Hospital, London: Laia Carsro, Anika Dewshi, Jola Karaj. University Hospitals Southampton NHS Foundation Trust, Southampton: Sumita Kerley.

    • Contributors LL, JB, RM, TB, HB, RC, PD, JWD, SD, SF, RG, EI, DJJ, MP, TP, IP, PEP, DBP, HR, SS, LGH and AM-G made substantial contributions to the study conception, design, data acquisition and interpretation. JB and RM led the statistical analysis. LL led on the writing and was primarily responsible for manuscript drafting and revisions. All authors commented on previous versions of the manuscript. AM-G is the guarantor of the paper. The final manuscript was approved by all the authors prior to submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests LL has no conflicts of interest. JB has attended advisory boards for NuvoAir, outside the submitted work. RM has no conflicts of interest. TB has received speaker fees from Astra Zeneca, Glaxo Smith Kline, Sanofi, Teva, Novartis and Chiesi; honoraria for advisory board attendance from Astra Zeneca, Sanofi and Teva; sponsorship to attend international scientific meetings from Sanofi, GSK, Teva, Chiesi and Napp Pharmaceuticals. HB has attended advisory board for AstraZeneca, GlaxoSmithKline and Sanofi; has given lectures at meetings with/without lecture honoraria supported by AstraZeneca, GlaxoSmithKline and Chiesi; has attended international conferences with AstraZeneca and Chiesi; has taken part in clinical trials sponsored by AstraZeneca, Chiesi, GlaxoSmithKline, Teva and Sanofi. RC has received lecture fees from GSK, AZ, Teva, Chiesi, Sanofi and Novartis; honoraria for Advisory Board Meetings from GSK, AZ, Teva, Chiesi, Novartis; sponsorship to attend international scientific meetings from Chiesi, Napp, Sanofi and GSK and a research grant to her Institute from AZ for a UK multicentre study. PD has received honoraria/consultancy fees/sponsorship from Teva, AZ, GSK, Novartis and Omron. JWD declares he has received honoraria for participating in advisory boards and given lectures at meetings supported by GSK, Boerhinger Ingelheim, Chiesi, AstraZeneca, Fisher & Paykel, Aerogen; he has received sponsorship for attending international scientific meetings from Chiesi; he has also taken part in asthma clinical trials sponsored by Sanofi, AstraZeneca, Chiesi for which his institution received remuneration. SD has received lecture fees from GSK, AZ, and Sanofi; honoraria for Advisory Board Meetings from GSK, AZ and Novartis; sponsorship to attend international scientific meetings from AZ, Chiesi, Sanofi and GSK. SF has received speaker fees/sponsorship to attend specialty meetings from AstraZeneca, GlaxoSmithKline, Chiesi, Novartis and Sanofi. RG has received speaking/lecture fees from GSK, AstraZeneca, Sanofi and Novartis. EI has no conflicts of interest. DJJ has received lecture fees from GSK, AZ, Teva, Chiesi, and Sanofi; honoraria for Advisory Board Meetings from GSK, AZ, Teva, Chiesi, Sanofi and Novartis; sponsorship to attend international scientific meetings from AZ, Chiesi, Napp, Sanofi and GSK and research grants to his Institute from AZ. MP has no conflicts of interest. TP has received sponsorship for attending international scientific meetings from Chiesi, GlaxoSmithKline and Sanofi Genzyme; he is also taking part in asthma clinical trials sponsored by AstraZeneca and Sanofi Genzyme for which his institution receives remuneration. IP has received speaker’s honoraria for speaking at sponsored meetings from Astra Zeneca, Boehringer Inglehiem, Aerocrine, Almirall, Novartis, Teva, Chiesi, Sanofi/Regeneron, Menarini and GSK and payments for organising educational events from AZ, GSK, Sanofi/Regeneron and Teva. He has received honoraria for attending advisory panels with Genentech, Sanofi/Regeneron, Astra Zeneca, Boehringer Ingelheim, GSK, Novartis, Teva, Merck, Circassia, Chiesi and Knopp and payments to support FDA approval meetings from GSK. He has received sponsorship to attend international scientific meetings from Boehringer Ingelheim, GSK, Astra Zeneca, Teva and Chiesi. He has received a grant from Chiesi to support a phase 2 clinical trial in Oxford. PEP has attended advisory board for AstraZeneca, GlaxoSmithKline and Sanofi; has given lectures at meetings with/without lecture honoraria supported by AstraZeneca and GlaxoSmithKline; has attended international conferences with AstraZeneca; has taken part in clinical trials sponsored by AstraZeneca, GlaxoSmithKline, Novartis and Sanofi; and is conducting research funded by GlaxoSmithKline for which his institution receives remuneration. DBP has advisory board membership with Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Viatris, Mundipharma, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, Teva Pharmaceuticals and Thermofisher; consultancy agreements with Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Viatris, Mundipharma, Novartis, Pfizer, Teva Pharmaceuticals and Theravance; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute) from AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Viatris, Mundipharma, Novartis, Pfizer, Regeneron Pharmaceuticals, Sanofi Genzyme, Teva Pharmaceuticals, Theravance and UK National Health Service; payment for lectures/speaking engagements from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Viatris, Mundipharma, Novartis, Pfizer, Regeneron Pharmaceuticals, Sanofi Genzyme and Teva Pharmaceuticals; payment for travel/accommodation/meeting expenses from AstraZeneca, Boehringer Ingelheim, Circassia, Mundipharma, Novartis, Teva Pharmaceuticals and Thermofisher; funding for patient enrolment or completion of research from Novartis; stock/stock options from AKL Research and Development Ltd which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 74% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); 5% shareholding in Timestamp which develops adherence monitoring technology; is peer reviewer for grant committees of the UK Efficacy and Mechanism Evaluation programme, and Health Technology Assessment; and was an expert witness for GlaxoSmithKline. HR has received lecture fees from GSK, AZ, Chiesi, and Sanofi; honoraria for Advisory Board Meetings from GSK, AZ and Teva; sponsorship to attend international scientific meetings from AZ and Sanofi and research grants to her Institute from GSK and AZ. SS has received honoraria for speaking or providing advisory services from AstraZeneca, Boehringer Inglehiem, GSK, CSL Behring, Chiesi, MUDIPHARMA, Owlstone Medical, ERT Medical. LGH declares he has received grant funding, participated in advisory boards and given lectures at meetings supported by Amgen, AstraZeneca, Boehringer Ingelheim, Circassia, Hoffmann la Roche, GlaxoSmithKline, Novartis, Theravance, Evelo Biosciences, Sanofi, and Teva; he has received grants from MedImmune, Novartis UK, Roche/Genentech, and Glaxo Smith Kline, Amgen, Genentech/Hoffman la Roche, Astra Zeneca, MedImmune, Glaxo Smith Kline, Aerocrine and Vitalograph; he has received sponsorship for attending international scientific meetings from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK and Napp Pharmaceuticals; he has also taken part in asthma clinical trials sponsored by Boehringer Ingelheim, Hoffmann la Roche, and GlaxoSmithKline for which his institution received remuneration; he is the Academic Lead for the Medical Research Council Stratified Medicine UK Consortium in Severe Asthma which involves industrial partnerships with a number of pharmaceutical companies including Amgen, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Hoffmann la Roche and Janssen. AM-G is an employee of Astra Zeneca.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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