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Scott Webb: Asthma is more common in women, especially young women than men. And though it is possible to live normal, healthy lives with asthma, avoiding triggers is critical for those who are living with asthma. And joining me today is Dr. Aaron Bruns. He's a board-certified physician in Pulmonary and Sleep Medicine and Critical Care with Franciscan Health.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, thanks so much for your time today. Before we get rolling here, let's maybe have a little bit of a baseline, so everybody's on the same page. What exactly is asthma or, in other words, what happens to folks when they suffer an asthma attack?

Dr. Aaron Bruns: Basically, asthma is a condition of the lungs where the airways, the tubes that go out to the lungs that allow you to breathe, they basically become inflamed and swollen and can narrow when exposed to certain things and cause a lot of difficulty breathing, cough, wheezing. And some people have symptoms every day. Some people, it only bothers them if they get an illness or if they're exposed to some kind of allergen. But it can vary quite a bit as far as how severe it can be.

Scott Webb: And you mentioned there the triggers, if you will. So let's talk about that. What are some of the most common triggers for asthma?

Dr. Aaron Bruns: So upper respiratory illnesses or colds or bronchitis, anything like that is probably one of the more common ones. Particularly in younger people, allergens or allergies can play a role. People who have allergies to grass, you know, they mow their yard, they suddenly can't breathe. Or, in some people, it's changes in the weather. Some people are affected by high humidity. Cold weather can be difficult. People exposed to cigarette smoke or strong perfumes can actually cause a flareup. So there can be a number of different things that can trigger them. And part of asthma is learning to identify what your triggers are.

Scott Webb: Yeah. And I wanted to ask you, because my son experienced this a little bit when he was in sports. It does seem like some folks, they just have the reaction to the triggers, as you're saying, and they can really kind of be doing nothing, just living their lives, whereas others maybe might be exercise-induced or there are things that can specifically bring on asthma, right?

Dr. Aaron Bruns: Right. And it's actually a separate entity called exercise-induced bronchospasm, which is basically the only time they're ever bothered by it is during exercise and then otherwise they're fine. And then a lot of people with asthma, they will notice the issues with exercise.

Scott Webb: Yeah, and that was definitely the case for my son. Now, on the flip side, I also have a daughter who's 13 who doesn't have asthma, but the primary focus today for our conversation is really young women and asthma. And so I want to ask you, are young women more prone to asthma than young men?

Dr. Aaron Bruns: So it depends on how young you go. If you go to before puberty, it's actually boys that have a higher incidence and they have more problems. And then there a gender shift once puberty kicks in and then it does become more common and more problematic in women. And it's probably related to the elevation in the sex hormones.

Scott Webb: Do we know why adolescents or young women are more prone to asthma than young men?

Dr. Aaron Bruns: We don't know for sure. We believe it's due to the sex hormones. And there are sort of receptors you can think of in the lungs called beta-2 receptors, which are the ones that control swelling and the constriction of the airways. And they can be activated by the ovarian hormones like estrogen and progesterone and things like that to become higher chance of the swelling and the contraction. And we believe that's the reason why it switches at puberty. But it's hard when you do research on those kinds of things to control for every other possible factor. So it's definitely possible that there could be something else in there also, but that's sort of the one thing that's obviously the one major difference between women and men once they hit puberty, is the different sex hormones involved.

Scott Webb: Yeah, I see what you mean. So the puberty is sort of the line of demarcation where it shifts, where, you know, boys before that are more prone and then young women become more prone at puberty. And so we have a sense of at least why that is. So I'm assuming that maybe then asthma can be worse for young women during their menstrual cycles?

Dr. Aaron Bruns: Correct. Yup. For the same reason, when their progesterone is at its highest. They can definitely get worse during their menstrual cycle.

Scott Webb: And can asthma cause problems for pregnant women as well?

Dr. Aaron Bruns: Yeah, it definitely can. People who have asthma have a 15% to 20% increased risk of preeclampsia, preterm delivery, low birth weight, even mortality or dying. And if you have severe asthma before you were pregnant, it actually goes to 30% to a 100% increased risk. And especially if they have an exacerbation while they're pregnant, that puts them at risk for all kinds of possible issues.

Scott Webb: I know there's no cure for asthma, but there are ways to treat asthma. So let's talk about this. Both for young women as they head into puberty and are more prone to asthma or possibly even pregnant women, how do you treat asthma?

Dr. Aaron Bruns: Generally, you treat it with controlling some environmental factors. So things that you know trigger it, if it's possible to avoid those things, that could be helpful or wear a mask, which I think we're probably all used to right now.

Scott Webb: Yeah. We are, unfortunately. Yeah.

Dr. Aaron Bruns: And then, medications, obviously inhalers. There's several different types of inhalers and different classes that are commonly used to control asthma. There are a couple of pill medications that could be added on if the inhalers aren't enough. And then, you know, in the last 10 years or so, there's been more and more of the injectable medicines, which are kind of once monthly injections that can also be used. Now, those are not standalone therapies. Those are to add to the inhalers, if they're not controlling things well enough.

Scott Webb: Yeah. And what's the quality of life expectation for young women or women who continue to suffer from asthma as they get older? Can these women live with asthma and just kind of live their normal daily lives, as you say, while trying to avoid the triggers perhaps?

Dr. Aaron Bruns: A lot of people with asthma can live pretty normal lives. Asthma is a spectrum. There are people who have a mild asthma that only bothers them at certain times and they're perfectly fine otherwise. And then there's all the way on the other end where they have, you know, severe asthma, which bothers them constantly. And those people, that group of people have a significant impact on their quality of life. They can have flareups, you know, numerous times throughout the year, they can be hospitalized for these things. So especially if you have really bad or difficult to control asthma, you definitely want to be followed closely by a specialist.

Scott Webb: Yeah. And I think the natural followup is, you know, obviously some folks as you say do have severe asthma, and maybe we don't exactly know why, but we have a sense of how it's treated. But asthma, why can it be so life-threatening?

Dr. Aaron Bruns: Again, asthma basically is swelling and constriction or the airways kind of tighten up. If they tighten up severe enough, a person can't breathe at all. Obviously, that can cause their oxygen levels to drop dangerously low and, without intervention, they can die from it.

And some people with asthma, that can happen pretty quickly. They can be perfectly fine and get exposed to something and then, you know, people are calling ambulances.

Scott Webb: So, you know, doctor, during COVID-19, we've heard a lot about comorbidities and folks that need to be, you know, on extra alert in terms of managing their healthcare, because they're more susceptible to severe cases of COVID-19. Is that the case with folks who are suffering from asthma?

Dr. Aaron Bruns: Absolutely. I think we discussed earlier one of the most common reasons for exacerbations is upper respiratory illnesses or viral colds, things like that. And here we have a very potent aggressive virus that has killed normal healthy people. So if you throw that on top of somebody who's got disease in their lungs, they're at a much higher risk. And it's definitely important if you have asthma to make sure it stays well-controlled, that you have close follow, that you stay on your medications and get your vaccine and wear your mask.

Scott Webb: This has been really educational. As we wrap up here, doctor, what are your takeaways about asthma in general, but specifically about women and asthma, why they're more prone and what they should do about it because they are more prone to asthma?

Dr. Aaron Bruns: As far as a preventive standpoint, there's not a whole lot that you can really do other than, you know, if you smoke, quit smoking, things like that. A few takeaway points. I mean, especially if you become pregnant and you have a history of asthma, particularly severe asthma, it's very important to not just stop your medications. I think people get worried that the medication is going to affect the fetus and I understand, but you're almost certain to cause problems if you just stop it without talking to somebody first. Most of these medications seem to be pretty safe during pregnancy and certainly the risks of an exacerbation and the problems that can cause outweigh, you know, the possible risks of the medicines.

Outside of that, for women, if you're obese, losing weight can help. If you're smoking, quit smoking can help. Make sure you take the medications as directed. You know, learn to identify your triggers and all of these things can kind of help keep things under control and you have a pretty good chance of living a relatively normal life.

Scott Webb: Yeah, that's the goal, especially for us parents with adolescent teenage girls. You know, we definitely want them to live normal, happy, healthy, active lives. So doctor, thanks so much for your time today, and you stay well

Dr. Aaron Bruns: Yes, you too. Thank you.

Scott Webb: For more information, go to franciscanhealth.org and search asthma and young women. And if you found this podcast to be helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.