Sex differences in asthma symptom profiles and control in the American Lung Association Asthma Clinical Research Centers

Abstract

Objective: Important differences between men and women with asthma have been demonstrated, with women describing more symptoms and worse asthma-related quality of life (QOL) despite having similar or better pulmonary function. While current guidelines focus heavily on assessing asthma control, they lack information about whether sex-specific approaches to asthma assessment should be considered. We sought to determine if sex differences in asthma control or symptom profiles exist in the well-characterized population of participants in the American Lung Association Asthma Clinical Research Centers (ALA-ACRC) trials.

Methods: We reviewed baseline data from four trials published by the ALA-ACRC to evaluate individual item responses to three standardized asthma questionnaires: the Juniper Asthma Control Questionnaire (ACQ), the multi-attribute Asthma Symptom Utility Index (ASUI), and Juniper Mini Asthma Quality of Life Questionnaire (mini-AQLQ).

Results: In the poorly-controlled population, women reported similar overall asthma control (mean ACQ 1.9 vs. 1.8; p = 0.54), but were more likely to report specific symptoms such as nocturnal awakenings, activity limitations, and shortness of breath on individual item responses. Women reported worse asthma-related QOL on the mini-AQLQ (mean 4.5 vs. 4.9; p < 0.001) and more asthma-related symptoms with a lower mean score on the ASUI (0.73 vs. 0.77; p ≤ 0.0001) and were more likely to report feeling bothered by particular symptoms such as coughing, or environmental triggers.

Conclusions: In participants with poorly-controlled asthma, women had outwardly similar asthma control, but had unique symptom profiles on detailed item analyses which were evident on evaluation of three standardized asthma questionnaires.

Keywords: ACQ; ALA-ACRC; ASUI; ATAQ; American Lung Association Asthma Clinical Research Centers; Asthma; Asthma Control Questionnaire; Asthma Symptom Utility Index; Asthma Therapy Assessment Questionnaire; BMI; Control; Effectiveness of Low Dose Theophylline as Add-On Therapy In Treatment of Asthma; FEV(1); GERD; LOCCS; LODO; MID; PC(20); QOL; SABA; SARA; Sex differences; Study of Acid Reflux and Asthma; Symptom profiles; TAPE; Trial of Asthma Patient Education; body mass index; forced expiratory volume in one second; gastroesophageal reflux disease; leukotriene or corticosteroid or corticosteroid–salmeterol trial; mini asthma quality of life questionnaire; mini-AQLQ; minimal clinically important difference; provocative concentration of methacholine; quality of life; short-acting beta-agonist.