Gender differences in asthma perception and its impact on quality of life: a post hoc analysis of the PROXIMA (Patient Reported Outcomes and Xolair® In the Management of Asthma) study

Abstract

Background: Gender differences in asthma perception and control have been reported. The PROXIMA observational study assessed these outcomes in a cohort of Italian severe allergic asthma (SAA) patients. This post hoc analysis of the PROXIMA results was aimed at assessing gender differences in SAA in a real-world setting, focusing on disease perception and impact on quality of life (QoL). Methods: The PROXIMA study was an observational, multicenter study, consisting of a cross-sectional and a prospective longitudinal phase, including adult outpatients diagnosed with SAA at step 4 requiring a therapeutic step-up. Patients on omalizumab treatment at baseline were included in the 12-month longitudinal phase. Disease control was assessed by the Asthma Control Questionnaire (ACQ) score, patients' disease perception by the Brief Illness Perception Questionnaire (BIPQ), and QoL by the EuroQoL five-dimensional three-level questionnaire (EQ-5D-3 L) at baseline and after 6 and 12 months. Two regression models were used to evaluate the association between gender and BIPQ total score and EQ-5D-3L score, respectively. Results: 357 patients (65% females) were analyzed for the cross-sectional phase and 99 (62.6% females) for the longitudinal phase. The prevalence of perennial and seasonal aeroallergens was similar between genders. ACQ score decreased similarly during omalizumab treatment at 6 and 12 months in both genders; no gender differences were observed in control rates. Asthma perception was worse among females at all study visits reaching statistical significance at 12 months (mean (SD) B-IPQ total score 41.8 (9.4) vs 35.6 (12.0); T test p-value (males vs females) < 0.05). Statistically significant gender differences were observed for some specific items, with males reporting less symptom experience, concern about the disease, and emotional impact at 12-months. The results of the multivariate regression model for repeated measures showed that overall treatment with omalizumab improved disease perception overtime regardless from gender. Males reported a significantly better QoL compared to females at both 6 and 12 months. Conclusions: In this real-world setting, females confirmed to have a worse perception of asthma, feel it as more symptomatic and suffer a greater impact on their QoL, even though having similar baseline severity and obtaining similar level of control.

Sex Differences in Severe Asthma: Results From Severe Asthma Network in Italy-SANI

“…Our study also showed that females with severe asthma have a poorer control of symptoms and a higher number of hospitalizations for asthma attacks than males, despite a similar level of FEV1 and a similar rate of severe exacerbations. These data are partially concordant with those reported in other national or international registries on severe asthma: in effect, some studies suggest that females have greater limitations to daily life activities due to asthma 29 30 ; on the contrary, other studies show that males have poorer pulmonary function than females. 12 In our study, the poorer control of asthma symptoms in females compared to males may have been attributed to the higher prevalence of comorbidities (obesity and GERD) in females, which may increase asthma-like symptoms and reduce the efficacy of anti-asthma treatments.…”

New Perspectives on Difficult Asthma; Sex and Age of Asthma-Onset Based Phenotypes

“…Furthermore, despite their smoking history they had highest FeNO levels (a biomarker that is normally suppressed by cigarette smoke) and trends for highest peripheral eosinophils, both signs of T2-high inflammation. Given their other disease features their low ACQ scores may actually represent relative symptom under-perception which is previously reported in males 49,50 .…”

A systematic review of illness representation clusters in chronic conditions

“…However, unlike age differences, no studies reported differences in the proportion of men and women between their cluster groups. Gender differences in illness representation subscale scores have been found (Colombo et al and Wisting et al are two recent examples), but when using a clustering approach on these chronic condition populations we no longer see that effect (Colombo, Zagni, Ferri, Canonica, & PROXIMA Study Centers, 2019; Wisting et al, 2016).…”