Fluctuations in female sex hormones can exacerbate asthma – so why is treatment still ‘one-size-fits-all’?


New analysis by Asthma + Lung UK has found that women in the UK are almost twice as likely to die from an asthma attack than men – a figure the charity attributes to a lack of awareness and research into the impact female hormone fluctuations can have on the condition.

Emma Amoscato was three years old when she experienced her first asthma attack. Now 40 and living in Bedfordshire, she had to deal with several bad attacks during her childhood, but her daily inhalers helped to keep things relatively stable.

When she reached puberty, however, things changed. While Amoscato’s asthma calmed down and “pretty much went away” by the time she turned seven, it began to flare up again when she turned 13 – a reality her newly teenage self was reluctant to admit.

“At that age, I pretty much wanted to ignore it and didn’t carry my inhalers very much, despite the fact that I would get very tight chested when I was cold or during exercise,” she explains. “I remember running up a long set of stairs to race a friend, and at the top, I could barely breathe or get any air in my lungs but had no inhaler. It was very scary and knowing what I know now, very stupid.”

Amoscato is not the only woman whose asthma has worsened during puberty – in fact, she’s far from it. While research into how asthma affects women is limited (and many women with asthma are unaware their sex can even play a role in their condition), it’s understood that fluctuations in female sex hormones can cause asthma symptoms to flare up or cause life-threatening asthma attacks.

Why this happens remains unclear (thanks largely to the aforementioned lack of research), but it’s been suggested that fluctuating hormone levels could increase inflammation levels in the body and affect the airways as a result.

As you might expect, the hormonal changes that take place during puberty are not the only ones that can have this effect – plenty of women experience flare-ups during pregnancy, when they start the menopause or simply due to fluctuations in their menstrual cycle.

“Women in the UK are almost twice as likely to die from an asthma attack than men – with women making up more than two-thirds of the people who have died from asthma over the last five years”

That’s the case for 38-year-old Zoe Lacey, who has noticed an increase in symptoms during the third week of her cycle. The Londoner – whose asthma has remained relatively mild throughout her life – says she notices a change in her condition as she progresses through the month.

“I track my cycle and there is definitely a time in my cycle, around week three, when my chest is significantly tighter, I’m shorter of breath and I need to use my inhaler,” she says. “I wasn’t really aware that asthma could be affected by hormones, but these changes in my symptoms definitely gave me a hunch, as I’ve searched online for menstrual cycle-related asthma symptoms several times.”

While Amoscato and Lacey haven’t experienced life-threatening symptoms, there are plenty of women for whom these hormonal changes present a very real danger.

According to new analysis by the UK’s leading lung health charity Asthma + Lung UK, women in the UK are almost twice as likely to die from an asthma attack than men – with women making up more than two-thirds of the people who have died from asthma over the last five years. The analysis also found that rates of admission to hospital are 2.5 times higher in women than in men aged 20-49.

The charity believes these statistics are partly down to the fact that there is still very little research into the link between asthma and hormones, leading to a lack of preventative treatment.

“When it comes to research funding women with asthma have drawn the short straw,” explained Sarah Woolnough, chief executive of Asthma + Lung UK. “Gaps in our knowledge are failing women, leaving them struggling with debilitating asthma symptoms, stuck in a cycle of being in and out of hospital and, in some cases, losing their lives.”

She continued: “By understanding the role of sex hormones in asthma, we could transform the lives of the 3 million women with the condition in the UK and the many millions of women with asthma across the world. We urgently need to see more investment in research in this area so we can find new treatments and better use existing treatments to help millions of women and save lives.”

The charity, which has launched a new report to tackle what it describes as a “stark health inequality”, is also encouraging GPs to discuss this potential trigger with their patients and look into adapting a patient’s care plan if their symptoms are worse during hormone fluctuations (for example, by upping preventer medication).

“Despite the UK having some of the most comprehensive health data in the world at its fingertips, data on sex hormones and asthma remains largely untapped and unexplored,” said Mome Mukherjee, a senior research fellow at the Asthma UK Centre for Applied Research and the University of Edinburgh’s Usher Institute, who has been involved in research into the link between sex hormones and asthma.

“There is not enough research into why women are more likely to be hospitalised and die from asthma and what treatments new and existing, could help women. The UK has a great opportunity to become a global leader in research on the link between sex hormones and asthma, which would benefit millions of women in the UK and around the world.”


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