An interdisciplinary analysis of sex and gender in relation to the pathogenesis of bronchial asthma.
BACKGROUND
An increasing number of studies confirm that pathogenesis and prevalence of bronchial asthma are age and sex dependent. Detailed physiological mechanisms of the changing sex ratios with age are not fully known, however, the gender (socio-cultural) factors are also imperative. Although multiple factors definitely influence the pathogenesis of asthma, only individual or few combinations of these have been investigated.


METHODS
The terms 'sex', 'gender' and plausible combinations of both were systematically researched in selected databases (Medline, Scopus) or other sources, including publications from January 2000 to June 2007. Generated articles were categorized, either as endogenous or exogenous factors influencing the pathogenesis of asthma, and divided into the following subgroups: genetic, immunological, hormonal, gynaecological, nutritional, and environmental parameters.


RESULTS
An increasing number of studies investigate the influence of sex and gender in the aetiology, therapy and prevention of asthma. While their results are still debatable, others regarding its initiation, perpetuation and cessation have been clarified. Recent insights into interactions at biomolecular and immunological levels greatly contribute to clarifying sex-specific influences. Despite occasional oversimplifications, a trend for explanations considering the complex interplay of different factors can be observed. This work is in line with this trend and offers explanation models from our point of view.


CONCLUSIONS
Some disagreements regarding the patho-physiology, diagnosis, treatment and prevention of asthma still prevail. Nevertheless, in order to better appreciate its complexity, openness to and persistent consideration for interdisciplinary as well as sex- and gender-related factors is required of the medical-research community in future investigations.
Lux
Richard
R
Institute of Epidemiology, Social Medicine and Health System Research, Hannover Medical School, OE 5410, Carl-Neuberg-Strasse 1, 30623 Hannover, Germany. lux.richard@mh-hannover.de
Awa
Wendy
W
Walter
Ulla
U
D000367:Age Factors; D001249:Asthma / Q000453:epidemiology / Q000209:etiology*; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012931:Social Environment