Asthma worse? Being female and a list of other factors might be the cause — based on Columbia University’s recently published data on research about women and asthma. They found that a number of factors led to greater difficulty with asthma including: hormones, obesity, stress, depression and PTSD (Post Traumatic Stress Disorder).
The researchers note that hormone levels (especially estrogen) impact the Th-2/ Th-1 balance that has been previously discussed in this newsletter. High estrogen leads to Th-2 predominance, which promotes allergy. Increased estrogen can come from the normal wax and wane of the menstrual cycle, pregnancy, hormone replacement or oral contraceptives.
Obesity is also pro-inflammatory via the Th-2 mechanism. Columbia found that as little as a 15pound weight loss by obese women asthmatics resulted in 20 percent improvement in their asthma.
The issue of stress and depression is a double bind. In general, women experience depression more frequently than men. The asthmatic condition itself can cause life stress and depression, but the opposite is also true: stress and depression cause worsening of asthma. The Columbia group found that upwards of 15 percent of women with poorly controlled asthma had unresolved issues from childhood sexual trauma. They consider this a form of PTSD.
Interestingly, they found strong correlation of PTSD and worsening asthma in military women who had service-related traumas. Stress, depression and PTSD all lead to a number of stress hormone changes by way of the adrenal glands, along with production of inflammatory molecules such as interleukins, substance-P, and natural killer-cell function.
African-American women seemed more prone to depression and PTSD than their Caucasian, Asian and Hispanic sisters. In yet another fallout from racial discrimination, Columbia found a strong correlation between African-American asthmatics who had experienced significant racial bias versus women who had not, in terms of severity of asthma and frequency of exacerbation.
The researchers’ take-home message is that both patients and doctors should be aware of the interplay and dynamic force of stress/depression and asthma.