Gender differences in bronchiectasis: a real issue?

Abstract

Gender differences in chronic respiratory disease, including cystic fibrosis and non-cystic fibrosis bronchiectasis are clinically apparent and of increasing importance. Differences in disease prevalence, severity and outcome are all described, however, the precise cause of the gender dichotomy and their associated underlying mechanisms have been poorly characterised. A lack of dedicated clinical and epidemiological research focused in this area has led to a paucity of data and therefore a lack of understanding of its key drivers. Diagnosis, disease pathogenesis and treatment response are all complex but important aspects of bronchiectasis with an evident gender bias. Broadening our understanding of the interplay between microbiology, host physiology and the environment in the context of chronic lung diseases, such as bronchiectasis, is critical to unravelling mechanisms driving the observed gender differences. In this review, epidemiological, biological and environmental evidence related to gender in bronchiectasis is summarised. This illustrates gender differences as a “real issue” with the objective of mapping out a future framework upon which a gender-tailored medical approach may be incorporated into the diagnosis, monitoring and treatment of bronchiectasis.Key pointsCF and non-CF bronchiectasis are complex, multifactorial chronic pulmonary diseases with gender-specific differences in their prevalence, clinical presentation and disease severity.Microbiology and host physiology (immune and inflammatory responses) are essential aspects of bronchiectasis that are influenced by gender.Sex steroid hormones vary in type, fluctuating pattern and concentration throughout life and between the genders with a potential central role in bronchiectasis-related gender differences.Gender-focused clinical and/or therapeutic intervention has the potential to narrow the observed gender gap occurring in bronchiectasis-related lung disease.Educational aimsTo summarise the existing knowledge base of gender-related differences in CF and non-CF bronchiectasis.To highlight key areas of importance in the diagnosis, monitoring and treatment of bronchiectasis that is amenable to clinical and/or pharmacological intervention to narrow the existing “gender gap”.

Sex Steroids Induce Membrane Stress Responses and Virulence Properties in Pseudomonas aeruginosa

“…We show that the concentration and chemical nature of the steroid hormone shape the level of response together with the membrane properties of the exposed P. aeruginosa strain. This finding might explain sex differences observed across a range of lung diseases affected by chronic Pseudomonas infections ( 1 , 2 , 4 ). Females with CF have earlier colonization ( 8 , 49 – 51 ) and mucoid conversion of P. aeruginosa ( 8 , 52 ), which in turn, translates to poorer clinical outcomes and higher mortality ( 8 , 52 – 54 ).…”

“…Clinical observations and research reveal that males are at higher risk for bacterial infection; however, females are more prone to develop more severe illness with poorer outcomes, particularly at reproductive age ( 1 – 3 ). Genetic, anatomical, social, and behavioral differences have all been advanced to explain these gender biases, however, more recently, variations in the host innate and adaptive immune responses under the control of sex steroid hormones have been proposed ( 4 – 6 ).…”

Repeatability of the 6-min walk test in non-cystic fibrosis bronchiectasis

“…In a study with Chinese subjects with bronchiectasis, women walked significantly less than men 21 . Besides the prevalence of bronchiectasis is higher in males, the disease is more severe in females due to the differences in physical and biological mechanisms, such as smaller lungs, earlier bacterial colonization, nutritional deficiencies, estrogen/progesterone modulate cilia beat affecting the mucociliary escalator and delayed diagnosis 22 .…”

The role of sex in particle‐induced inflammation and injury

“…Epidemiological and clinical evidence has demonstrated that of the 1 billion people world‐wide suffering from acute or chronic lung disease, a disproportionate number of these individuals are women (Forum of International Respiratory Societies & European Respiratory Society, ; Fuentes & Silveyra, ). Lung diseases that present with increased incidence and/or severity in women include: non and cigarette‐mediated chronic obstructive pulmonary disease (COPD, particularly the chronic bronchitis form), autoimmune lung disease, pulmonary hypertension (Pinkerton et al, ), bronchiectasis (non and cystic fibrosis‐related; Vidaillac, Yong, Jaggi, Soh, & Chotirmall, ), chronic respiratory symptoms due to air pollution from ozone and particulate matter (Fuentes, Roy, Mishra, Cabello, & Silveyra, ; Yoshizaki et al, ), and adult asthma (Carey, Card, Voltz, Arbes Jr, ). However, there are also a number of lung diseases that affect men disproportionately, such as lung cancer and pulmonary fibrosis (Fuentes et al, ; Sathish & Prakish, 2016).…”