How Hormones Influence Asthma Development and Severity

Asthma is a lifelong condition. While some children may stop having symptoms as they get older, there is no cure for the disease. These people still have asthma, and their symptoms may reappear if they are exposed to a trigger later in life.

One factor that may contribute to changes in asthma symptoms is hormones. Sex hormones – estrogen and testosterone – play a distinct role in the development and severity of asthma. 

Factors That Influence Asthma

Asthma symptoms can be influenced by genetic, environmental and hormonal factors.

Genetics plays a role in asthma development. If a parent has asthma, their child is more likely to develop asthma. In fact, there is a 25% chance their child will have asthma, too. These children are also at a higher risk of developing asthma at a younger age.

Environmental factors also have an effect. Children who live on a farm are less likely to have asthma. Asthma is more common among children who are of poor socioeconomic status and have high exposure to indoor air pollution such as cigarette smoke.

Finally, hormonal factors play a strong role in the development and severity of asthma. These hormonal factors also differ based on the gender and age of the asthmatic patient.

Influence of Hormones in Childhood Asthma

The sex hormones estrogen and testosterone are believed to play a role in the development and severity of asthma symptoms.

This is first demonstrated by the gap in the number of asthma diagnoses between girls and boys before puberty. Before puberty, asthma is 16% more prevalent in boys than girls –boys are twice as likely to develop asthma and four times as likely to develop chronic asthma in childhood.

This difference is believed to be attributed to testosterone levels. “Testosterone seems to have a protective effect on the lungs,” shares Kathryn Williams, MD, a pulmonologist with ProMedica Physicians Pulmonary/Sleep Medicine – Sylvania. This means that when boys hit puberty, and more testosterone is released in their bodies, asthma symptoms and severity often improve.

Unfortunately for girls, asthma symptoms and severity often worsen in puberty. This is believed to be attributed to an increased production of the hormone estrogen. “Unlike testosterone, estrogen puts more of a strain on the lungs,” Dr. Williams shares. In adulthood, asthma is 62% more prevalent in women than in men.

How Hormonal Changes Affect Women With Asthma

For women, hormone levels are constantly changing based on many factors. While age plays a role in hormone levels, so does a woman’s monthly menstrual cycle, pregnancy, menopause and external factors such as hormonal contraception.

Typically, any change that causes an increase in estrogen is accompanied by an increase in asthma symptoms or severity. Women may notice a worsening of asthma symptoms in the days leading up to ovulation in their cycle when estrogen levels peak.

In pregnancy, asthma flare-ups are common. Physicians believe that this is related to the significant hormonal changes seen during pregnancy. Seeking care for unmanageable asthma symptoms during pregnancy is important for the health and well-being of the mother and unborn child. 

Because hormonal contraception methods such as birth control pills, patches and rings contain estrogen, many women notice a worsening in asthma symptoms when using them.

Finally, many women notice a decrease in asthma symptoms and severity during menopause. This is believed to be because of the reduction in the body’s production of estrogen.

Recommendations for Dealing with Changes in Symptoms

Unfortunately, avoiding these changes in asthma symptoms associated with age, gender and hormones is mostly unavoidable. To better deal with these changes in symptoms, Dr. Williams recommends being aware of your asthma triggers, keeping a journal of your symptoms and seeking out medical attention when a worsening of asthma symptoms occurs.

“Asthma triggers are different for each person,” Dr. Williams explains. “For some people, it may be pet dander, others dust, and others seasonal allergies.”

To better avoid things that trigger asthma, Dr. Williams recommends the following for individuals with asthma:

• Do not allow pets in the bedroom or on furniture.
• Keep an air purifier in the bedroom to decrease dust in the air.
• Keep your sheets clean and dry your pillows often for one hour on medium heat to rid of dust mites.
• Take over-the-counter antihistamines to manage allergies.

“If you have asthma, it’s so important to have yearly well-visits with your primary care provider. Also, follow up with them if you notice a change or worsening in your asthma symptoms,” Dr. Williams explains. “An early evaluation can help exponentially with long-term management.”

Sources

DeBoer MD, Phillips BR, Mauger DT, et al. Effects of endogenous sex hormones on lung function and symptom control in adolescents with asthma. BMC Pulm Med 2018;18 (1):58

Mohan SS, Knuiman MW, Divitini ML, James AL, Musk AW, Handelsman DJ, et al. Higher serum testosterone and dihydrotestosterone, but not oestradiol, are independently associated with favourable indices of lung function in community-dwelling men. Clin Endocrinol 2015;83:268-76

Nerys Williams, How Sex and Gender Impact Clinical Practice: An Evidence-Based Guide to Patient Care, Occupational Medicine, Volume 71, Issue 6-7, August-October 2021

Kathryn Williams, MD
Dr. Williams is a pulmonologist with ProMedica Physicians Pulmonary/Sleep Medicine - Sylvania. View her profile.