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Gender differences in asthma PowerPoint Presentation

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Published on : Dec 06, 2013
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Gender differences in asthma Presentation Transcript

Slide 1 -

Gender differences in asthma: unsolved puzzles Dirkje Postma University Medical Center Groningen

Slide 2 -

The Burden of Asthma: increasing prevalence in children/adolescents Asthma is a significant burden not only in terms of health care costs, but also in lost productivity and reduced participation in family and social life The prevalence of asthma is increasing worldwide, especially among children Available at: http://www.ginasthma.com. Slide 21. 2003. Finland (Haahtela et al) Sweden (Aberg et al) Japan (Nakagomi et al) Scotland (Rona et al) UK (Omran et al) New Zealand (Shaw et al) Prevalence, %

Slide 3 -

ppt slide no 3 content not found

Slide 4 -

Asthma: a benign disease? sudden attacks of breathlesness and/or cough allergy (generally) reversible airway obstruction hyperresponsiveness

Slide 5 -

Age frequent persistent episodic 7 2.1 3.8 14 2.1 4.0 21 1.5 1.5 28 1.3 1.8 Age and asthma - male : female ratio Clough Cl Exp All 1993

Slide 6 -

1979 1.6 1.4 1.2 1.0 Male Female 1983 1987 1991 1995 1997 1.8 0.8 Rate per 100,000 population year Age-adjusted death rate due to asthma in USA Source:National Center for Health Statistics

Slide 7 -

Underdiagnosis in females -girls -parents -doctor Especially in low-income group Childhood asthma - boy:girl ratio

Slide 8 -

Treatment of asthma: age 7-12 wheeze allergen exercise morning symptoms symptoms tightness 20 40 60 Male Female 0 Percentage treated 80 100 Kuhni et al Ped Pulm 1995 * * *

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Airway obstruction! Before 10 minutes after allergen inhalation

Slide 10 -

Sex hormones Interaction between sex hormones and immune function Women are more susceptible to specific immunological disorders Better B cell mediated immunity Higher Ig levels Higher CD4 to CD8 ratios

Slide 11 -

Sex hormones and asthma In humans data remain inconclusive Mouse model: Estrogen: increases BALF eosinophilia in oophorectomized rats with asthma (Ligeiro de Oliveira et al. 2004) Progesterone: increases airway inflammation in male mice with asthma (Hellings et al. 2003) Testosterone: Castration of male asthmatic mice increases BALF eosinophilia (Hayashi et al. 2003)

Slide 12 -

OVA-specific IgE in serum PBS OVA PBS OVA 0 . 0 0 . 5 1 . 0 1 . 5 2 . 0 2 . 5 | - - - - - - M a l e - - - - - - | | - - - - - F e m a l e - - - - | * * * * * * * * *

Slide 13 -

Cytokines in lung tissue IL-5 RANTES PBS OVA PBS OVA 0 5 0 0 1 0 0 0 1 5 0 0 2 0 0 0 | - - - - - - M a l e - - - - - - | | - - - - - F e m a l e - - - - | * * * * * * PBS OVA PBS OVA 0 1 0 0 2 0 0 3 0 0 | - - - - - - M a l e - - - - - - | | - - - - - F e m a l e - - - - | * * Post-hoc analysis: ** p<0.01 *** p<0.001 - -

Slide 14 -

Barnes PJ Progression of asthma into (partial) irreversible airway obstruction

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Airway Branching Morphogenesis

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Lung growth in children girls have larger airways in proportion to lung volume than boys puberty 2 years

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Males Females CC CT TT CC CT TT -60 -50 -40 -30 -20 -10 0 10 20 p=0.01 p=0.04 ns ns Exon 1 +30 T/C Mean annual decline in FEV1 (ml/year) 19 35 18 10 29 9 n= Genotype ESR1 and lung function decline Dijkstra et al J All CLin Imm 2006

Slide 18 -

Gender effect of inhaled corticosteroids? Convery et al ERJ 2000 0.5 1.5 2.0 0 2.5 1.0 Male Female Doubling dose increase in PD20 methacholine *

Slide 19 -

-50 -40 -30 -20 -10 0 Mean annual FEV1 decline in asthma Inhaled steroids - + - + P < 0.01 Dijkstra et al 2005 submitted male female

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less prevalent in girls more prevalent in female adults due to airway and lung growth hormonal changes hyperresponsiveness immune development Conclusions on asthma

Slide 21 -

In females more severe higher mortality more and longer hospitalisations (except boys) less response to inhaled steroids? different interaction with genetic background? hormonal influence? Conclusions on asthma

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