Figures
- Figure 1
The pathophysiology of bronchiectasis may be influenced by sex steroid hormones, which potentially account for some of the observed gender dichotomy in CF and non-CF bronchiectasis. Bronchiectasis is the result of a “vicious cycle” of chronic inflammation and infection that leads to frequent and recurrent exacerbations [6, 7]. Sex steroid hormones potentially play an important role in the pathophysiology of the disease through anatomical variation, regulation of lung function and altering microbiota composition, as well as influencing host immune and inflammatory response [19, 20, 21, 22–24]. Age, environmental factors and comorbidities are also important key components, directly or indirectly affecting the nature and concentration of sex steroid hormones [CC] and, therefore, potentially influencing gender differences observed in bronchiectasis [19, 20, 21, 22–26]. E: oestrogens; FSH: follicle-stimulating hormone; LH: luteinizing hormone; HCG: human chorionic gonadotropin; E2: oestradiol; P4: progesterone.
- Figure 2
A summary of known gender differences in the prevalence and severity of CF and non-CF bronchiectasis by age and during pregnancy. Areas with no or sparse data are indicated. a) While data are sparse in paediatric populations, bronchiectasis confirmed by high-resolution computed tomography scans of the thorax suggest a 2:1 male:female ratio in patients aged <18 years [1, 18, 32]. b) Severity of bronchiectasis is greater in females than in males [1, 3, 31]. Prevalence of CF is reported to be higher in males, while females surpass males in non-CF bronchiectasis [3, 13, 20, 53, 54]. c) Prevalence and severity data are not available in the elderly due to a shortened life expectancy in CF. In non-CF bronchiectasis, prevalence is higher in males, although females present with clinically more severe disease [18, 21, 22, 33, 34]. d) Pregnancy is increasingly reported in CF patients. Although severity of the disease appears similar in pregnant and non-pregnant patients, poorer lung function prior to pregnancy appears to be a risk factor for complications and worse clinical outcomes during pregnancy [35, 36]. FEV1: forced expiratory volume in 1 s.
- Figure 3
Gender differences in the lung microbiome in CF and non-CF bronchiectasis. The nature of respiratory pathogens predominant in patients with CF and non-CF bronchiectasis is gender specific [32, 135–138]. Females have higher risks of Pseudomonas aeruginosa colonisation and mucoid conversion in both CF and non-CF bronchiectasis [54, 111].
