2025-26 Project (Pembrey & Rutter & Cooper)

Sex differences in asthma in children and adolescents

SUPERVISORY TEAM

Supervisor

Dr Lucy Pembrey at LSHTM
Email: lucy.pembrey@lshtm.ac.uk

Co-Supervisor

Dr Charlotte Rutter at LSHTM
Email: charlotte.rutter1@lshtm.ac.uk

Co-Supervisor

Prof Philip Cooper at City St George’s
Email: pcooper@sgul.ac.uk

PROJECT SUMMARY

Project Summary

Asthma is a chronic respiratory disease that causes significant ill health globally. Asthma prevalence differs by sex; it is higher in boys in early childhood with a crossover around the time of puberty, and higher in women than in men in adulthood. It is widely assumed that sex hormones play a role but the potential mechanisms remain unclear. The subtypes of asthma may also differ by sex. Our previous research has shown that females were more likely to have non-eosinophilic (or non-allergic) asthma than males.    

The aim of this PhD project is to investigate age-sex differences in asthma incidence and prevalence using existing birth cohort and cross-sectional laboratory data from several different settings in both high-income and low- and middle-income countries.   

Differences in asthma severity and subtype by age and sex, and associations with laboratory markers will elucidate mechanisms of asthma, which could ultimately lead to improvements in treatment.

Project Key Words

Asthma, sex differences, non-atopic asthma, cohorts

MRC LID Themes

  1. Global Health
  2. Health Data Science

Skills

MRC Core Skills

  1. Quantitative skills
  2. Interdisciplinary skills

Skills we expect a student to develop/acquire whilst pursuing this project

Statistical analysis skills; combining and comparing evidence from different settings. Collaboration in an interdisciplinary team.

Routes

Which route/s are available with this project?

  • 1+4 = No
  • +4 = Yes

Possible Master’s programme options identified by supervisory team for 1+4 applicants:

  • Not applicable

Full-time/Part-time Study

Is this project available for full-time study? Yes
Is this project available for part-time study? Yes

Location & Travel

Students funded through MRC LID are expected to work on site at their primary institution, meeting – at the minimum – the institutional research degree regulations and expectations. Students may also be required to travel for conferences (up to 3 over the duration of the studentship), and for any required training (for research degree study). Other travel expectations and opportunities highlighted by the supervisory team are noted below.

Primary location for duration of this research degree: LSHTM, London

Travel requirements for this project: Short visits to Bradford and a 3-month visit to Ecuador.

Eligibility/Requirements

Particular prior educational requirements for a student undertaking this project

  • Minimum LSHTM institutional eligibility criteria for doctoral study.
  • MSc in epidemiology or biostatistics, or equivalent.

Other useful information

  • Potential Industrial CASE (iCASE) conversion? = No

PROJECT IN MORE DETAIL

Scientific description of this research project

It is well established that the prevalence of asthma is higher in boys than in girls before puberty and that there is a crossover around the time of puberty, leading to a higher prevalence in women than in men in adulthood. It is widely assumed, although not yet established, that sex hormones may play a role. Other evidence, including premenstrual asthma and a decline in asthma incidence post menopause, also indicates a role of sex hormones in the development or severity of asthma. However, these potential mechanisms remain speculative. If we could better understand the population patterns, this would not only facilitate population prevention of asthma (particularly in adult women), but also may shed light on the underlying mechanisms.  

In particular, non-allergic mechanisms for asthma may be important. In our ERC-funded World ASthma Phenotypes (WASP) study (age-range 8 – 27 years), we found that females were more likely to have non-eosinophilic asthma (NEA) than males in all five centres (Brazil, Ecuador, New Zealand, Uganda, UK). Little is known about mechanisms of NEA or non-atopic asthma (work is underway to elucidate causes and mechanisms in our CAMERA study, which is funded by a second ERC grant), but sex hormones could be involved. Most asthma treatments target atopic asthma so there could be more uncontrolled asthma in females if non-atopic asthma is more common in females than in males. This would have implications for the clinical management of asthma.   

1. Project objectives 
The aim of this PhD project is to investigate age-sex differences in asthma incidence, prevalence and severity, by disease subtype, using existing birth cohort and cross-sectional data from several different settings in both high-income and low- and middle-income countries.   

2. Techniques to be used 
Statistical techniques appropriate for longitudinal birth cohort data and linked primary care and hospital data will be required. Analysis of cross-sectional laboratory data will explore and contrast potential mechanisms of sex differences in atopic and non-atopic asthma.   

3. Confirmed availability of any required databases or specialist materials 
Data are available on asthma diagnoses, severity and subtype (based on measures of atopy) from the following: 
– Born in Bradford birth cohort, UK. 
– The Study Team for Early Life Asthma Research (STELAR) consortium which includes five UK birth cohorts: Avon Longitudinal Study of Parents and Children (ALSPAC), Ashford cohort (Kent), Isle of Wight cohort, Manchester Asthma and Allergy Study (MAAS), and the Study of Eczema and Asthma To Observe the effects of Nutrition (SEATON, Aberdeen).  
– The Ecuador Life (ECUAVIDA) birth cohort study. 

Cross-sectional laboratory data from the WASP study on immune and inflammatory mediators in sputum supernatant, DNA methylation in sputum, sputum microbiome profiles and sensitisation to allergens are available for children and adolescents in Brazil, Ecuador, New Zealand, Uganda, and the UK.    

4. Potential risks to the project and plans for their mitigation 
No risks identified as the data required for the project are already collected.

Further reading

Relevant preprints and/or open access articles:
(DOI = Digital Object Identifier)

Additional information from the supervisory team

The supervisory team has provided a recording for prospective applicants who are interested in their project. This recording should be watched before any discussions begin with the supervisory team.

Pembrey-Rutter-Cooper recording

MRC LID LINKS

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