Differences between men and women in reporting of symptoms during an asthma exacerbation.
OBJECTIVE
Compared with men, women presenting to the emergency department with acute asthma are more likely to be admitted and to have a longer hospital stay. This study compares peak expiratory flow rate (PEFR) with reported symptom severity between men and women with acute asthma. The null hypothesis was that men and women report similar severity symptoms for similar levels of airway obstruction.


METHODS
This study combined data from 4 prospective cohort studies performed from 1996 to 1998 as part of the Multicenter Airway Research Collaboration. Using a standardized protocol, investigators at 64 EDs in 21 US states and 4 Canadian provinces provided 24-hour per day coverage for a median of 2 weeks.


RESULTS
Of the 1,291 patients with moderate to severe exacerbations (initial percentage of predicted PEFR <80%), 62% were women. Women were more likely than men to report "severe" complaints in terms of symptom frequency, symptom intensity, and resulting activity limitations (all P <.05). Women with moderate exacerbations were especially likely to describe their exacerbation as causing "severe" activity limitations (sex-PEFR interaction, P =.05).


CONCLUSIONS
Men are less likely than women to report severe asthma symptoms and activity limitations in the presence of airway obstruction. This finding supports use of objective measures of airway obstruction when managing patients with asthma so that those whose symptoms do not reflect the severity of their obstruction can be recognized and properly treated. It also reconfirms the need for increased research on differences between men and women in acute asthma.
Cydulka
R K
RK
Department of Emergency Medicine, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109-1998, USA. rcydulka@metrohealth.org
Emerman
C L
CL
Rowe
B H
BH
Clark
S
S
Woodruff
P G
PG
Singh
A K
AK
Camargo
C A
CA
D000328:Adult; D001249:Asthma / Q000453:epidemiology / Q000503:physiopathology*; D002170:Canada / Q000453:epidemiology; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D014481:United States / Q000453:epidemiology