Asthma answer may not be steroids for women
For women depending on steroids to treat severe asthma, their body's estrogen may not only be preventing the treatment from working effectively, but making the asthma worse, according to a recent Western study.
"We had assumed estrogen would just affect how well the steroid works—it didn't. It makes them different and more aggressive," said Lauren Solomon, a postdoctoral scholar working with Pathology and Laboratory Medicine professor Lisa Cameron. "The steroids are still suppressing inflammation. So the symptoms are being treated. But it's not treating the actual white blood cells causing it. So when they get exposed to another allergen, the asthma comes again—and it's worse."
Currently affecting about three million Canadians, Asthma is a chronic inflammatory disease of the airway. While sufferers' airways are inflamed, to some degree, all the time, the more inflamed the airway the more difficulty they have in breathing.
When Solomon began working with Cameron, they noticed women with severe asthma differed from their male counterparts. Determined through blood samples, women had more of a specific T cell—a type of white blood cell of key importance to the immune system—than the men, making Solomon wonder if it was related to "those pesky sex hormones."
She began working with cell culture models from blood donors, adding estrogen and steroids. She found that while women with severe asthma were being prescribed steroids—some getting the maximum allowable dose—nothing was happening. In fact, things got worse in some instances.
"We can treat the cells for 24 hours with estrogen and steroids and the next day, when we activate them, they produce way more mediators, meaning the next time they are exposed to an antigen, it's worse," she said.
Solomon is continuing her work by exploring specific RNA sequencing targets where she can enumerate the cells, allowing her to determine whose medication is not working and making them better candidates for newer therapies or medications.
"If we can get this information out there, if we can influence prescribing habits, there are alternative drugs that are already approved," she said. "We can now say if it's a woman going through menopause taking hormone replacement therapy, maybe check her estrogen levels."