SELECTED ARTICLES FROM THE RECENT LITERATURE 2004

12/30/04

Pre-menstrual asthma flares

Summary
Background - Worsening of asthma during the pre-menstrual time period (PMA) is fairly common. However, the mechanisms underlying PMA are unclear.

Findings - The subject of PMA was reviewed by Redmond et al of the Univ. of Tennessee in Memphis. Some studies have found worsening of asthma during the pre-menstrual period in up to 40% of female asthmatics who are in the menstruating age group. Although the etiology/pathogenesis of PMA is not defined, most investigators feel that hormonal changes play a role. The most impressive correlation has been between worsening asthma and the rapid reduction in serum progesterone (Prog) levels just prior to onset of the menses. Prog has known bronchodilator and anti-inflammatory effects. Thus, a sudden decrease in Prog levels could be responsible for the increased bronchial inflammatory signs present in the pre-menstrual period.

Also, asthmatics do not exhibit the increased expression of beta 2 adrenergic receptors seen in non-asthmatics during the pre-menstrual time period. There are conflicting findings whether there is greater bronchial hyper-reactivity in asthmatics during the pre-menstrual period.

Reference
J Asthma 2004:41:687-93

Editor's Comments
These comments deal with a fairly common occurrence in my experience. The treatment of increased asthma manifestations in PMA is similar to that used when asthma worsens at other times of the month. However, one must be sure that the patient taking NSAID agents for control of peri-menstrual symptoms is not one of the 20% of asthmatics whose asthma is worsened by ingestion of aspirin or NSAID agents.

 

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