Reconsidering Gender in Asthma: Is It All About Sex? A Perspective Review

Abstract

Asthma is a prevalent chronic condition, affecting an estimated 260 million people worldwide, according to the 2021 Global Burden of Disease Study. This condition significantly impacts individuals of all ages. One notable finding is that asthma prevalence among adults was higher in females than males. Recent evidence suggests that these disparities in asthma prevalence and outcomes are likely due to complex interactions among hormonal, anatomical, and environmental factors, coupled with societal and behavioral influences. The interchangeable use of the terms "sex" and "gender" in the scientific literature is frequently inconsistent. Biological sex is defined by anatomical and physiological characteristics determined by genetics; "gender", on the other hand, is a more complex construct and a universally accepted definition is still lacking. This lack of clarity, coupled with potential knowledge gaps, misunderstandings, or the inherent difficulty in differentiating sex- and gender-related effects, often leads to the terms being poorly defined or used interchangeably. Such imprecise usage hinders accurate data interpretation and research progress. This paper provides a perspective review synthesizing current knowledge regarding the influence of sex and gender on asthma, specifically focusing on their impact on disease pathogenesis, clinical presentation, severity, and management strategies.

Keywords: asthma; exacerbation; gender; perspective; review; severity.

Figure 1

Representation of lung dysanapsis. Lung and trachea–bronchi icons by Servier (https://smart.servier.com/) are licensed under CC-BY 3.0 Unported (https://creativecommons.org/licenses/by/3.0/, accessed on 28 March 2025).

Figure 2

A schematic representation of inflammatory pathways in asthma: T2 inflammation is reported in green, non-T2 inflammation in yellow. AHR: airway hyperresponsiveness; FENO: exhaled nitric oxide fraction; IFN: interferon; IL: interleukin; ILC2: type 2 innate lymphoid cell; Th: T-helper cell; TNF: tumour necrosis factor; TSLP: thymic stromal lymphopoietin. Image taken from [7].

Figure 3

Summary of sex- and gender-specific factors affecting asthma, including biological, environmental, and lifestyle factors, and their impact on disease outcomes.