Symptomatic sex differences in patients with severe asthma free of exacerbations and maintenance oral corticosteroids under biologic treatment.

INTRODUCTION Symptomatic control is a key domain of clinical remission (CR) in management of severe asthma. However, little is known about sex differences in symptomatic burdens, particularly in patients with asthma who receive biologics and meet other domains of CR, including no exacerbation in a past year and no maintenance oral corticosteroid (OCS) use. This study examined sex differences in symptoms assessed with asthma control test (ACT) in these patients.

METHODS Of consecutive patients with severe asthma who completed ACT after at least one year of biologic treatment, those with OCS-free and past-year exacerbation-free conditions were retrospectively included to explore sex differences in ACT scores.

RESULTS A total of 72 female and 46 male patients with asthma were included. ACT score was significantly lower in females than males (22.0 and 24.0, p <0.01). The rate of ACT score ≥23 was lower in females than males after adjusting for confounding variables (odds ratio =0.24, 95% confidence interval [0.10, 0.55], p <0.001), whereas the rate of ACT score ≥20 did not differ. In a sub-analysis, ACT scores prior to biologic were assessed in 48 females and 31 males. After biologic, ACT scores improved in both sexes. However, pre-treatment ACT scores were lower in females (19.5 vs. 22.0, p = 0.048).

DISCUSSION Symptomatic burdens are greater in female patients with asthma maintaining exacerbation-free and OCS-free conditions under biologic treatments compared to male counterparts. This sex difference may cause a lower rate of CR in females particularly when CR requires almost complete symptomatic resolution.