Asthma and lower airway disease
Gender differences in asthma development and remission during transition through puberty: The TRacking Adolescents' Individual Lives Survey (TRAILS) study

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Background

During puberty, a gender shift in asthma prevalence occurs, with a preponderance of boys before puberty. The mechanisms underlying this gender shift are unclear.

Objectives

We assessed associations of pubertal stages and transition through puberty with (1) the prevalence, incidence, and remission of asthma in male and female subjects; (2) total IgE levels; and (3) peak expiratory flow (PEF) fall during a shuttle run test (SRT).

Methods

In the TRacking Adolescents' Individual Lives Survey study (n = 2,230; 51% female subjects), associations between pubertal stages and the prevalence, incidence, and remission of asthma were tested by using logistic regression and generalized estimating equations at a mean age of 11.1 (SD, 0.6), 13.6 (SD, 0.5), and 16.3 (SD, 0.7) years. Multiple linear regression analyses were used to study log-transformed total IgE levels and PEF fall during a SRT dependent on early versus late pubertal stages at a mean age of 16.3 years.

Results

The prevalence of asthma was similar in boys (7.7%) and girls (7.4%) at a mean age of 11.1 years. The prevalence of asthma was significantly higher in female (6.2%) than male (4.3%) subjects at 16.3 years of age. There were no significant associations between transition of pubertal stages and the presence of asthma, either cross-sectionally or longitudinally. Pubertal stages and log-transformed total IgE levels or PEF fall during a SRT at age 16.3 years were not correlated.

Conclusions

A shift in the prevalence of asthma occurs between 11.1 and 16.3 years, which is due to both an increased incidence and decreased remission of asthma in female compared with male subjects. Pubertal stages could not be proved to explain the gender shift in asthma prevalence.

Section snippets

Study population

The TRacking Adolescents' Individual Lives Survey (TRAILS) is a prospective cohort study among adolescents in the general Dutch population. Thus far, 3 surveys have been completed: survey 1 in 2001-2002 (mean age, 11.1 [SD, 0.6] years), survey 2 in 2003-2004 (mean age, 13.6 [SD, 0.5] years), and survey 3 in 2005-2007 (mean age, 16.3 [SD, 0.7] years). Adolescents will be followed until at least the age of 24 years. Detailed information has been described elsewhere.22, 23

Questionnaire data

Data were collected on

Study population

A total of 2,230 adolescents with a mean age of 11.1 (SD, 0.6) years was included (51% female subjects, Table I). At the second survey, 96% (n = 2149) were reassessed (mean age, 13.6 [SD, 0.5] years; 51% female subjects). Eighty-one percent of the original number (n = 1816) completed the third survey (mean age, 16.3 [SD, 0.7] years; 52% female subjects) (see Fig E1 in this article's Online Repository at www.jacionline.org). Adolescents who completed the third survey were significantly more

Discussion

Our longitudinal study in a large group of boys and girls followed through puberty did not show differences in asthma prevalence between boys and girls at the age of 11.1 and 13.6 years, whereas at 16.3 years of age, more female than male subjects had asthma. This higher prevalence of asthma at the age of 16.3 years was related to a higher incidence of asthma and lower remission of asthma in female compared with male subjects during this follow-up. This study did not show an association between

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  • Cited by (0)

    This research was funded by a grant of the Netherlands Asthma Foundation (grant no. 3.4.07.034). This research is embedded in TRAILS. Centers participating in TRAILS include various Departments of the University of Groningen, the Erasmus Medical Center of Rotterdam, the University of Nijmegen, the Trimbos Institute, and the University of Utrecht, The Netherlands. TRAILS is financially supported by grants from the Netherlands Organization for Scientific Research (GB-MW 940-38-011, GB-MAG 480-01-006, ZonMw 100.001.001; NWO 175.010.2003.005), the Department of Justice, and by the participating centers.

    Disclosure of potential conflict of interest: The authors have declared that they have no conflict of interest.

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