Severe Asthma in Women: Clinical Characteristics and Pharmacological Implications for Tailored Management

Sex-specific differences in severe asthma - particularly those affecting women - remain underexplored, despite their potential impact on disease management and outcomes. A better understanding of these differences is key to advancing personalized and equitable care. Multiple population-based cohorts have reported a higher prevalence of asthma in adult women than in men, underscoring the clinical relevance of sex-based differences. The objective is to describe and compare sex-based clinical and pharmacological profiles among patients with severe asthma managed at a Severe Asthma Clinic (SAC) in a tertiary hospital in Spain.

This retrospective cohort study included adult patients with severe asthma followed at the SAC in 2024. Clinical variables (comorbidities, pulmonary function, biomarkers, and asthma control) and pharmacological variables (inhaled therapy prescriptions and adherence, rescue overuse, oral corticosteroid use, biologics, and comorbidity-related treatments) were analyzed using electronic health and pharmacy records.

A total of 223 patients were included (157 women and 66 men). Women showed significantly poorer asthma control (Asthma Control Test 18.3 vs. 21.5, p < 0.05), lower fractional exhaled nitric oxide and IgE levels (p < 0.05), and higher rates of depression/anxiety (18.5% vs. 6.1%, p = 0.012). Pulmonary function tests revealed higher forced vital capacity (FVC) but lower forced expiratory volume in 1 s (FEV₁)/FVC ratios in women (p < 0.05). Poor adherence to inhaled therapies (26.0% vs. 15.4%, p < 0.05) and intranasal corticosteroids (59% vs. 34.6%, p = 0.038), as well as higher oral corticosteroid use (20.6% vs. 15.1%, p = 0.031), were more frequent in women. Biologic prescription rates and rescue inhaler overuse were similar between sexes.

Women with severe asthma exhibit distinct clinical and pharmacological profiles that warrant sex-specific approaches to improve disease management and outcomes.