• Asthma

For decades, the unwritten rule for asthma management was ‘Keep it Simple’, with clinicians largely trying to apply a one-size-fits-all stepwise approach to hundreds of millions of people across the globe. More recently, our broader understanding, increasing array of targeted therapies, and relatively stagnant outcomes have led to a greater acknowledgement of the complexity that needs to be addressed.1 However, despite progress, our therapeutic pathways do not account for some basic patient characteristics such as sex. The impacts of sex and gender on asthma pathogenesis, prevalence and manifestation throughout life have been studied to some degree, but the study by Loewenthal et al in this issue of Thorax 2 focusing on severe asthma is a welcome addition to the literature. The authors have used the UK Severe Asthma Registry (UKSAR) and Optimum Patient Care Research Database (OPCRD) to evaluate sex differences in disease characteristics, symptom control, exacerbations, core biological phenotypes and treatment in patients with severe asthma using a retrospective epidemiological approach.2 They found that women report a greater symptom burden despite having better lung function and inflammatory profiles compared with males. This finding was apparent in mild, moderate or severe asthma.

It is well recognised that men …