Asthma: men and women, the same disease?

By Ana Espino | Published on May 5, 2026 | 4 min read  



Asthma is a chronic inflammatory disease of the airways characterized by bronchial hyperresponsiveness, excessive mucus production, and variable inflammation. It is not a single condition, but rather a group of phenotypes based on different immunological mechanisms.

A major feature of asthma is the existence of marked sex differences that evolve over the course of life. Asthma is more common in boys during childhood, then becomes more prevalent and often more severe in women in adulthood. These variations suggest a key role for sex hormones, as well as genetic and immunological factors.

However, the precise mechanisms underlying these differences remain incompletely understood. The data are heterogeneous, particularly depending on life stages (childhood, pregnancy, menopause), and the interactions between hormones, the immune system, and the environment are complex.

In this context, this article, recently published in Immunological Reviews, aims to better understand how sex hormones and chromosomal differences influence the pathophysiology of asthma, in order to pave the way for more personalized therapeutic strategies.

Why does asthma differ by sex?

Asthma involves multiple inflammatory mechanisms. Type 2 (Th2) inflammation leads to eosinophil infiltration, mucus production, and bronchial hyperresponsiveness, while non–type 2 forms involve neutrophils and Th1/Th17 responses.

Differences between men and women appear from childhood. Boys have a higher incidence, notably due to anatomical factors (smaller airways) and a more pronounced immune response. In contrast, in adulthood, women experience more exacerbations and greater morbidity.

These variations are largely explained by the effects of sex hormones:

• Androgens have a protective effect by reducing airway inflammation and improving lung function
• Estrogens, via the ER-α receptor, promote certain inflammatory responses, notably by increasing IL-33 production and activating Th2 and Th17 pathways

Hormonal fluctuations also play a key role. In women, symptoms may vary during the menstrual cycle, worsen during pregnancy, or change after menopause.

Other factors are involved, such as obesity, which increases inflammation—particularly in women—and viral infections, whose impact differs by sex. Finally, differences in gene expression linked to the X chromosome also contribute to modulating the immune response.

Toward a differentiated approach?

Asthma is a complex disease whose expression varies according to sex and life stage. This review highlights the central role of sex hormones in modulating bronchial inflammation and disease severity.

Androgens appear overall protective, while estrogens may amplify certain inflammatory responses, which could explain the greater severity observed in adult women.

Beyond these observations, this work underscores the importance of better taking into account sex differences in the understanding and management of asthma.

“Understanding sex-related differences in asthma is essential to adapt treatments and improve patient care,” the authors suggest. It now remains to further explore the role of sex chromosomes, better characterize hormonal effects across different stages of life, and integrate these data into personalized therapeutic strategies at the intersection of immunology, endocrinology, and precision medicine.

Read next : The role of psychological interventions in asthma management  

About the author – Ana Espino
PhD in Immunology, specialized in Virology  
As a scientific writer, Ana is passionate about bridging the gap between research and real-world impact. With expertise in immunology, virology, oncology, and clinical studies, she makes complex science clear and accessible. Her mission: to accelerate knowledge sharing and empower evidence-based decisions.