Exploring the role of sex in asthma and COPD pharmacological treatment

Sex is a fundamental determinant in pharmacology, influencing disease prevalence, severity, and therapeutic responses. Differences in pharmacokinetics and pharmacodynamics between men and women contribute to variations in drug efficacy and safety profiles. While sex refers to biological and physiological characteristics, gender encompasses social and behavioral factors. Despite their distinct meanings, these terms are often used interchangeably in medical research, potentially leading to misinterpretations. Historically, female and intersex individuals have been underrepresented in clinical studies, resulting in biased treatment approaches. Acknowledging these disparities, researchers now emphasize the importance of sex-specific differences to enhance therapeutic outcomes. This review explores the impact of sex on the pharmacological treatment of chronic obstructive respiratory diseases, particularly asthma and chronic obstructive pulmonary disease (COPD). Asthma is more prevalent in women, whereas COPD severity is rising among female patients. Sex influences the response to bronchodilators, inhaled corticosteroids (ICS), and combination therapies. Studies suggest that men exhibit a greater response to β₂-adrenoceptor agonists and sex differences in muscarinic acetylcholine receptor (mAChR) expression may influence bronchodilator response to muscarinic antagonists. Moreover, women display stronger immune responses and higher corticosteroid receptor expression, potentially modulating the efficacy of ICS. Women are also more likely to experience adverse drug reactions and face challenges in correct inhaler device use, impacting treatment adherence and clinical outcomes. Despite these differences between men and women, sex-specific approaches remain insufficiently integrated into clinical practice. Addressing sex disparities in pharmacotherapy is crucial to optimize treatment strategies. Further research is needed to elucidate sex-related differences and incorporate them into evidence-based guidelines for asthma and COPD management.