Sex differences in adult asthma and COPD therapy: a systematic review

Abstract

Background Although asthma is more prevalent in women and the prevalence of COPD is increasing in women, the current international recommendations for the management and prevention of asthma and COPD provide no sex-related indication for the treatment of these diseases. Therefore, we systematically reviewed the evidence across literature on the sex-related effectiveness of asthma and COPD therapy. Methods This systematic review has been registered in PROSPERO and performed according to PRISMA-P. The PICO framework was applied for the literature search strategy: "patient problem” included adult patients suffering from asthma or COPD, “Intervention” regarded the pharmacological treatments for asthma or COPD, “Comparison” was vs. baseline, active controls, or placebo, “Outcome” was any difference sex-related in the effectiveness of interventions. Results In asthma 44% of the evidence reported that men responded better than women to the therapy, whereas this percentage was 28% in COPD. ICS was generally less effective in women than in men to treat asthma, and consistent evidence suggests that in asthmatic patients ICS/LABA/LAMA combination may be equally effective in both men and women. Due to the inconsistent available evidence, it is not possible to identify specific treatments whose effectiveness is related to sex difference in COPD patients. Conclusions There is a strong need of investigating the sex-related impact of asthma and COPD treatments. Pre-specified analyses in men and women should be planned in future trial protocols, a necessary condition that should be requested also by the regulatory agencies to overcome the anachronistic “one-size-fits-all” approach to therapeutics associated with suboptimal outcomes for patients.

Sex differences in comorbidities and mortality risk among patients with chronic obstructive pulmonary disease: a study based on NHANES data

“…Compared to men, women had a significantly higher prevalence of asthma (OR 1.93, 95% CI 1.46 to 2.57, p <0.001), and these findings are consistent with those of other studies [ 26 , 27 ]. A recent systematic review of sex differences in adult asthma and COPD also found that asthma is more prevalent among women [ 27 ]. Moreover, the prevalence of asthma was not associated with a higher risk of mortality among men and women in our study.…”

Sex-differences in COPD: from biological mechanisms to therapeutic considerations

“…Major classes of inhaled medications for COPD include long-acting muscarinic antagonists (LAMA), long-acting beta agonists (LABA), combination LABA-LAMA, and combination inhaled corticosteroid (ICS)-LABA. A recent systematic review of randomized controlled trials and observational studies found that there is limited data directly comparing treatment effectiveness between sexes in COPD; however, there is evidence from retrospective and sub-group analyses of large randomized controlled trials ( 57 ). When clinical trials report sex-differences, they are frequently not found; however, some trials may not be powered to detect differences in treatment response between females and males.…”

Consideration of Sex, Gender, or Age on Outcomes of Digital Technologies for Treatment and Monitoring of Chronic Obstructive Pulmonary Disease: Overview of Systematic Reviews

“…In general, as individuals age, the likelihood of developing the condition increases [1,15], and diagnostic and therapeutic approaches vary depending on sociodemographic factors (sex, gender, or age) [8][9][10][11][12][13][16][17][18][19]. For example, although women tend to exhibit more severe symptoms of COPD than men throughout their lifespan [13], they may also respond better to specific treatments [9].…”