Abstract Rationale Despite evidence of worse asthma outcomes in women, sex bias in assessing asthma control remains understudied. For patients aged ≥12 years, the Asthma Impairment and Risk Questionnaire (AIRQ®) is superior in evaluating current control and predicting exacerbations versus physician assessment and the ACT ®. We evaluated sex disparities in asthma morbidity for specialist-managed adolescents and adults to evaluate if bias in treatment decisions based upon physician assessment exists and whether the AIRQ could reduce bias in assessment and management. Methods Patients who participated in the AIRQ validation study were included. Severe exacerbations were assessed for the 12 months before and after study enrollment. Baseline HRQoL was measured by SGRQ and control by AIRQ and ACT, with results unavailable to physicians. Physician assessment of control and treatment decisions were determined after history, physical examination, and chart review. Differences by sex in asthma morbidity, assessment, and management were compared by chi-square, McNemar, and Student’s t-tests (p ≤ 0.05). Results 748 females and 316 males were included: mean(SD) age=43.9(19.3); 13% Black/African American race, 79% White race; 6% Hispanic/Latino ethnicity. Females had worse HRQoL versus males: SGRQ score=34.2(18.9) versus 24.1(17.7), p 0.001. A greater proportion of females than males had prior-12-month exacerbations (46.8% vs 27.8%, p 0.001) and worse baseline control per ACT (46.3% vs 56.0% well-controlled, 24.7% vs 28.2% not well-controlled NWC, 29.0% vs 15.8% very poorly controlled VPC , p 0.001) and AIRQ (32.1% vs 42.7% well-controlled, 36.1% vs 43.0% NWC, 31.8% vs 14.2% VPC, p 0.001) (Figure). Females had higher step levels of therapy (p 0.001) than males, but biologic use was similar (9.6% vs 7.0%, p = 0.16). Physician assessment of control did not differ for females versus males (52.3% vs 58.2% well-/completely controlled, p = 0.07), nor did intention to step up therapy (19.3% vs 18.4%, p = 0.80). 46.8% of females versus 27.8% of males had a subsequent-12-month exacerbation (p 0.001), with a larger proportion of females with asthma rated well-/completely controlled by physicians (40.2%) and well-controlled by the ACT (36.7%) versus well-controlled by AIRQ (29.6%) experiencing exacerbations (each comparison p 0.001). Conclusions Physicians demonstrated sex-blind treatment patterns that failed to address the greater asthma morbidity experienced by adolescent and adult females. Although our observations suggest absence of overt sex bias, they represent a form of outcome bias in which equal treatment of unequal conditions perpetuates disparities. AIRQ-based treatment could outperform management decisions guided by ACT or physician assessment, offering an opportunity to reduce sex disparities in identification and treatment of uncontrolled disease and asthma morbidity. This abstract is funded by: AstraZeneca
Reibman et al. (Fri,) studied this question.