Einfluss von Hormon-, Immun- und Nervensystem - Geschlechtsspezifische Unterschiede bei Asthma bronchiale

Zusammenfassung

Die Prävalenzrate von Asthma bronchiale steigt in den westlichen Industrienationen stetig an, wobei der größte Zuwachs an Asthmaerkrankungen unter Kindern und jungen Erwachsenen zu beobachten ist. Daher ist Asthma bronchiale eine Erkrankung, die dem klinisch tätigen Arzt in seinem medizinischen Alltag immer häufiger begegnet. In den USA beträgt die derzeitige Lebenszeitprävalenz für Asthma bronchiale bereits 10,5 %, in Deutschland sind ungefähr 10 % der Kinder und 5 % der Erwachsenen von Asthma bronchiale betroffen. Die Geschlechterverteilung zeigt, dass Frauen eine höhere Prävalenzrate für Asthma bronchiale haben als Männer (9,1 versus 5,1 %). Aber nicht nur bei Asthma bronchiale überwiegen Frauen unter den Patienten, auch bei Adipositas und Migräne ist der Anteil an Frauen deutlich höher als der Anteil an Männern. Interessanterweise weisen beide dieser Erkrankungen eine gehäufte Komorbidität mit Asthma bronchiale auf. Warum gerade diese Erkrankungen bei Frauen häufiger auftreten, ist wissenschaftlich noch nicht hinreichend untersucht. Wir möchten in dieser Übersichtsarbeit den Einfluss des Hormonsystems, des Immunsystems und des Nervensystems auf die Manifestation und den Verlauf von Asthma bronchiale vor dem Hintergrund von geschlechtsspezifischen Unterschieden in diesen drei Systemen beleuchten.

Summary

In the western industrialized countries, the prevalence of bronchial asthma is constantly increasing, with the greatest increase in asthma cases being seen among children and young adults. This makes bronchial asthma a disease that the clinically active physician will encounter ever more frequently in his daily medical routine. Currently, the lifetime prevalence of the condition in the USA is 10,5 %, while in Germany, approximately 10 % of children and 5 % of adults are afflicted. The gender distribution shows that women have a higher prevalence for asthma than men (9,1 to 5,1 %). Women clearly outnumber men with regard not only to asthma, but also to obesity and migraine. Interestingly, both of the two latter conditions have an accumulated comorbidity rate with bronchial asthma. The question as to why these two conditions in particular occur more frequently in women has, to date, not been adequately investigated scientifically. In this review article, we take a look at the influence of the hormone, immune and nervous systems on the manifestation and course of bronchial asthma against the background of gender-specific differences in the three systems mentioned.

Key Words

gender - sex hormones - gonadal steroids - progesterone - estrogen - asthma - stress

Literatur

• 1 Abdul-Karim RW, Marshall LD, Nesbitt Jr. RE. Influence of estradiol-17 beta on the acetylcholine content of the lung in the rabbit neonate.  Am J Obstet Gynecol. 1970;  107 641-644
• 2 Anderson HR, Pottier AC, Strachan DP. Asthma from birth to age 23: incidence and relation to prior and concurrent atopic disease.  Thorax. 1992;  47 537-542
• 3 Belloch A, Perpina M, Martinez-Moragon E. et al. . Gender differences in health-related quality of life among patients with asthma.  J Asthma. 2003;  40 945-953
• 4 Bicikova M, Dibbelt L, Hill M. et al. . Allopregnanolone in women with premenstrual syndrome.  Horm Metab Res. 1998;  30 227-230
• 5 Buske-Kirschbaum A, Fischbach S, Rauh W. et al. . Increased responsiveness of the hypothalamus-pituitary-adrenal (HPA) axis to stress in newborns with atopic disposition.  Psychoneuroendocrinology. 2004;  29 705-711
• 6 Buske-Kirschbaum A, Geiben A, Hollig H. et al. . Altered responsiveness of the hypothalamus-pituitary-adrenal axis and the sympathetic adrenomedullary system to stress in patients with atopic dermatitis.  J Clin Endocrinol Metab. 2002;  87 4245-4251
• 7 Buske-Kirschbaum A, von Auer K, Krieger S. et al. . Blunted cortisol responses to psychosocial stress in asthmatic children: a general feature of atopic disease?.  Psychosom Med. 2003;  65 806-810
• 8 Chandler MH, Schuldheisz S, Phillips BA, Muse KN. Premenstrual asthma: the effect of estrogen on symptoms, pulmonary function, and beta 2-receptors.  Pharmacotherapy. 1997;  17 224-234
• 9 Chhabra SK. Premenstrual asthma.  Indian J Chest Dis Allied Sci. 2005;  47 109-116
• 10 Derimanov GS, Oppenheimer J. Exacerbation of premenstrual asthma caused by an oral contraceptive.  Ann Allergy Asthma Immunol. 1998;  81 243-246
• 11 Dorhofer DM, Sigmon ST. Physiological and psychological reactivity in women with asthma: the effects of anxiety and menstrual cycle phase.  Behav Res Ther. 2002;  40 3-17
• 12 Eliasson O, Scherzer HH, DeGraff AC Jr. Morbidity in asthma in relation to the menstrual cycle.  J Allergy Clin Immunol. 1986;  77 87-94
• 13 Foster PS, Goldie RG, Paterson JW. Effect of steroids on beta-adrenoceptor-mediated relaxation of pig bronchus.  Br J Pharmacol. 1983;  78 441-445
• 14 Gibbs CJ, Coutts II, Lock R. et al. . Premenstrual exacerbation of asthma.  Thorax. 1984;  39 833-836
• 15 Gissler M, Jarvelin MR, Louhiala P, Hemminki E. Boys have more health problems in childhood than girls: follow-up of the 1987. Finnish birth cohort.  Acta Paediatr. 1999;  88 310-314
• 16 Gluck JC. The change of asthma course during pregnancy.  Clin Rev Allergy Immunol. 2004;  26 171-180
• 17 Hamano N, Terada N, Maesako K, Ikeda T, Fukuda S, Wakita J, Yamashita T, Konno A. Expression of histamine receptors in nasal epithelial cells and endothelial cells-the effects of sex hormones.  Int Arch Allergy Immunol. 1998;  115 220-227
• 18 Hamano N, Terada N, Maesako K, Numata T, Konno A. Effect of sex hormones on eosinophilic inflammation in nasal mucosa.  Allergy Asthma Proc. 1998;  19 263-269
• 19 Hellings PW, Vandekerckhove P, Claeys R. et al. . Progesterone increases airway eosinophilia and hyper-responsiveness in a murine model of allergic asthma.  Clin Exp Allergy. 2003;  33 1457-1463
• 20 Henriksen AH, Holmen TL, Bjermer L. Gender differences in asthma prevalence may depend on how asthma is defined.  Respir Med. 2003;  97 491-497
• 21 Kaur B, Anderson HR, Austin J. et al. . Prevalence of asthma symptoms, diagnosis, and treatment in 12-14 year old children across Great Britain (international study of asthma and allergies in childhood, ISAAC UK).  BMJ. 1998;  316 118-124
• 22 Kjellman B, Gustafsson PM. Asthma from childhood to adulthood: asthma severity, allergies, sensitization, living conditions, gender influence and social consequences.  Respir Med. 2000;  94 454-465
• 23 Kuhni CE, Sennhauser FH. The Yentl syndrome in childhood asthma: risk factors for undertreatment in Swiss children.  Pediatr Pulmonol. 1995;  19 156-160
• 24 Lam SM, Huang SC. Premenstrual asthma: report of a case with hormonal studies.  J Microbiol Immunol Infect. 1998;  31 197-199
• 25 Leadbeater BJ, Kuperminc GP, Blatt SJ, Hertzog C. A multivariate model of gender differences in adolescents' internalizing and externalizing problems.  Dev Psychol. 1999;  35 1268-1282
• 26 Ligeiro AP de Oliveira, Oliveira-Filho RM, da Silva ZL. et al. . Regulation of allergic lung inflammation in rats: interaction between estradiol and corticosterone.  Neuroimmunomodulation. 2004;  11 20-27
• 27 Lis G, Breborowicz A, Swiatly A. et al. . Prevalence of allergic diseases in schoolchildren in Krakow and Poznan (based on a standardized ISAAC questionnaire).  Pneumonol Alergol Pol. 1997;  65 621-627
• 28 Martinez-Moragon E, Plaza V, Serrano J. et al. . Near-fatal asthma related to menstruation.  J Allergy Clin Immunol. 2004;  113 242-244
• 29 Matsuo N, Shimoda T, Matsuse H, Kohno S. A case of menstruation-associated asthma: treatment with oral contraceptives.  Chest. 1999;  116 252-253
• 30 Moawad AH, River LP, Kilpatrick SJ. The effect of estrogen and progesterone on beta-adrenergic receptor activity in rabbit lung tissue.  Am J Obstet Gynecol. 1982;  144 608-613
• 31 Monteleone P, Luisi S, Tonetti A. et al. . Allopregnanolone concentrations and premenstrual syndrome.  Eur J Endocrinol. 2000;  142 269-273
• 32 Nickel R, Illi S, Lau S. The German Multicenter Allergy Study Group (MAS-90).  Variability of total serum immunoglobulin E levels from birth to the age of 10 years. A prospective evaluation in a large birth cohort (German Multicenter Allergy Study).  Clin Exp Allergy. 2005;  35 619-623
• 33 Nicolai T, Pereszlenyiova-Bliznakova L, Illi S. et al. . Longitudinal follow-up of the changing gender ratio in asthma from childhood to adulthood: role of delayed manifestation in girls.  Pediatr Allergy Immunol. 2003;  14 280-283
• 34 Ninan TK, Russell G. Respiratory symptoms and atopy in Aberdeen schoolchildren: evidence from two surveys 25 years apart.  BMJ. 1992;  304 873-875
• 35 Oh YM, Kim YS, Yoo SH. et al. . Association between stress and asthma symptoms: a population-based study.  Respirology. 2004;  9 363-368
• 36 Pasanen S, Ylikomi T, Syvala H, Tuohimaa P. Distribution of progesterone receptor in chicken: novel target organs for progesterone and estrogen action.  Mol Cell Endocrinol. 1997;  135 79-91
• 37 Perusquia M, Hernandez R, Montano LM. et al. . Inhibitory effect of sex steroids on guinea-pig airway smooth muscle contractions.  Comp Biochem Physiol C Pharmacol Toxicol Endocrinol. 1997;  118 5-10
• 38 Peterson AP, Altman LC, Hill JS. et al. . Glucocorticoid receptors in normal human eosinophils: comparison with neutrophils.  J Allergy Clin Immunol. 1981;  68 212-217
• 39 Redmond AM, James AW, Nolan SH, Self TH. Premenstrual asthma: Emphasis on drug therapy options.  J Asthma. 2004;  41 687-693
• 40 Rees L. Anaetiological Study Of premenstrual Asthma.  Psychosom Res. 1963;  52 191-197
• 41 Robert-Koch-Institut .Abzurufen unter www.rki.de . 2005
• 42 Shamssain MH, Shamsian N. Prevalence and severity of asthma, rhinitis, and atopic eczema: the north east study.  Arch Dis Child. 1999;  81 313-317
• 43 Siroux V, Curt F, Oryszczyn MP. et al. . Role of gender and hormone-related events on IgE, atopy, and eosinophils in the Epidemiological Study on the Genetics and Environment of Asthma, bronchial hyperresponsiveness and atopy.  J Allergy Clin Immunol. 2004;  114 491-498
• 44 Skobeloff EM, Spivey WH, Silverman R. et al. . The effect of the menstrual cycle on asthma presentations in the emergency department.  Arch Intern Med. 1996;  156 1837-1840
• 45 Tan KS, McFarlane LC, Lipworth BJ. Paradoxical down-regulation and desensitization of beta2-adrenoceptors by exogenous progesterone in female asthmatics.  Chest. 1997;  111 847-851
• 46 Trethewie ER. Testosterone and asthma.  Nature. 1963;  198 290
• 47 Venn A, Lewis S, Cooper M. et al. . Questionnaire study of effect of sex and age on the prevalence of wheeze and asthma in adolescence.  BMJ. 1998;  316 1945-1946
• 48 Vliagoftis H, Dimitriadou V, Boucher W. et al. . Estradiol augments while tamoxifen inhibits rat mast cell secretion.  Int Arch Allergy Immunol. 1992;  98 398-409
• 49 Vrieze A, Postma DS, Kerstjens HA. Perimenstrual asthma: a syndrome without known cause or cure.  J Allergy Clin Immunol. 2003;  112 271-282
• 50 Whitacre CC, Reingold SC, O'Looney PA. A gender gap in autoimmunity.  Science. 1999;  283 1277-1278
• 51 Wiesner G, Todzy-Wolff I, Hoffmeister H. Andere Allergien.  In: Die Gesundheit der Deutschen: Ein Ost-West-Vergleich.  SozEp-Hefte. 1994;  4 84-90
• 52 Williams C. Doing health, doing gender: teenagers, diabetes and asthma.  Soc Sci Med. 2000;  50 387-396
• 53 Wulfsohn NL, Politzer WM. Bronchial Aathma During Menses And Pregnancy.  S Afr Med J. 1964;  38 173
• 54 Zannolli R, Morgese G. Does puberty interfere with asthma?.  Med Hypotheses. 1997;  48 27-32
• 55 Zhao XJ, McKerr G, Dong Z. et al. . Expression of oestrogen and progesterone receptors by mast cells alone, but not lymphocytes, macrophages or other immune cells in human upper airways.  Thorax. 2001;  56 205-211

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