Dr Joe Zein Describes Factors Associated With Asthma

Joe Zein, MD, PhD, from Cleveland Clinic, explains factors apart from sex and age that can have an impact on a patient's asthma.

Changes in immunity, environmental factors, and medication adherence can all impact asthma severity, said Joe Zein, MD, PhD, a staff physician in the Department of Pulmonary Medicine at Cleveland Clinic.


Are there any potential explanations for sex- or age-based differences in asthma?

There is a huge interaction. One would be, age changes the immunity, and the relationship between sex hormones and the immune system, that's number one. But also, as you mentioned, the exposures and environmental factors, they can do that. Basically, most of the changes happen between the relationship between sex hormones over the lifespan and the immune system, and mostly how it affects gene regulation, for example, and whether gene regulation across the lifespan in men is different than women and how sex hormones also affect gene regulation. Based on that, we see how asthma prevalence and severity changes over the lifespan.

What other factors can affect asthma?

In terms of asthma, there's lots of factors. Asthma is not just simply a disease, because it can have many interactions that go on together. The big 2 are aging and sex, but also there's the environmental factor, changes in immunity, genetic factors, and compliance with medication, pharmacodynamics, and all these things—and sometimes obesity and diet also. To be able to give the person the best answer they need for their asthma therapy, any physician or health care provider has to take all those aspects in asthma [into account]. Otherwise, it will not work.

I can give you a very small example. I had a patient who used to take nonsteroidal anti-inflammatory drugs, like ibuprofen, before her menstrual period and each time she took it she ended up having an asthma attack. In this case, all you have to say is, "Oh, your asthma is getting worse, because of your nonsteroidal anti-inflammatory drugs; just stop it." You do that and then the patient does not want to see you anymore. That's why it's important to give the time, look at all the triggers, and take into consideration all of this complex network of interactions [so] that at the end, you will be able to help patients with asthma.

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