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Premenstrual Asthma

Epidemiology, Pathogenesis and Treatment

  • Therapy in Practice
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Abstract

The exacerbation of asthma in the premenstrual period has long been of interest. Premenstrual asthma has been estimated to affect up to 40% of females with asthma, although the exact prevalence of this phenomenon is unclear as studies have involved small numbers in hospital clinics. Large-scale community-based studies are required to estimate its true prevalence.

Researchers are slowly piecing together clues as to the aetiology and pathogenesis of the disorder. Female sex-steroid hormones play an important role but the exact mechanism is still unknown. Recent evidence suggests that increased airway hyperresponsiveness, an indicator of underlying airway inflammation, during the luteal phase of the menstrual cycle may account for premenstrual exacerbations. In addition, there is now evidence of impaired or altered β2-adrenoceptor function and regulation in females with asthma, which may have a part to play.

Accurate diagnosis is dependent on a detailed history and the demonstration of premenstrual dip in peak expiratory flow. Exacerbations in the majority of women will respond to the usual treatment of bronchial asthma. However, a few women will experience significant morbidity or treatment-related adverse effects. Case reports suggest that the combined oral contraceptive pill or gonadotrophin-releasing hormone analogues may be effective in these patients. This requires substantiation by randomised controlled trials.

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References

  1. Frank R. The hormonal causes of premenstrual asthma. Arch Neurol Psychiatry 1931; 26: 1053

    Article  Google Scholar 

  2. Rees L. An aetiological study of premenstrual asthma. J Psychosom Res 1963; 7: 191–7

    Article  Google Scholar 

  3. Hanley S. Asthma variation with menstruation. Br J Dis Chest 1981; 75: 306–8

    Article  PubMed  CAS  Google Scholar 

  4. Gibbs C, Coutts I, Lock R, et al. Premenstrual exacerbation of asthma. Thorax 1984; 39: 833–6

    Article  PubMed  CAS  Google Scholar 

  5. Eliasson O, Scherzer H, DeGraff A. Morbidity in asthma in relation to the menstrual cycle. J Allergy Clin Immunol 1986; 77: 87–94

    Article  PubMed  CAS  Google Scholar 

  6. Agarwal AK, Shah A. Menstrual-linked asthma. J Asthma 1997; 34: 539–45

    Article  PubMed  CAS  Google Scholar 

  7. Shames RS, Heilbron DC, Janson SL, et al. Clinical differences among women with and without self-reported perimenstrual asthma. Ann Allergy Asthma Immunol 1998; 81: 65–72

    Article  PubMed  CAS  Google Scholar 

  8. Forbes L, Jarvis D, Bumey P. Is pre-menstrual asthma related to use of aspirin or non-steroidal anti-inflammatory drugs? Respir Med 2000; 94: 828–9

    Article  PubMed  CAS  Google Scholar 

  9. Skobeloff E, Spivey W, St Clair S, et al. The influence of age and sex on asthma admissions. JAMA 1992; 268: 3437–40

    Article  PubMed  CAS  Google Scholar 

  10. Skobeloff E, Spivey W, Silverman R, et al. The effect of the menstrual cycle on asthma presentations in the emergency department. Arch Intern Med 1996; 156; 1837–40

    Article  PubMed  CAS  Google Scholar 

  11. Zimmerman JL, Woodruff PG, Clark S, et al. Relation between phase of menstrual cycle and emergency department visits for acute asthma. Am J Respir Crit Care Med 2000; 162: 512–5

    PubMed  CAS  Google Scholar 

  12. Barkman R. Sudden death in asthma [letter]. Med J Aust 1981; 1: 316

    PubMed  CAS  Google Scholar 

  13. Lenoir R. Severe acute asthma and the menstrual cycle. Anaesthesia 1987; 42: 1287–90

    Article  PubMed  CAS  Google Scholar 

  14. Dawson B, Horobin G, Illsley R, et al. A survey of childhood asthma in Aberdeen. Lancet 1969; I: 827–30

    Article  Google Scholar 

  15. Tan KS, Thomson NC. Asthma in pregnancy. Am J Med 2000; 109: 727–33

    Article  PubMed  CAS  Google Scholar 

  16. Zondeck B, Bromberg YM. Endocrine allergy. Allergic sensitivity to endogenous hormones. J Allergy 1948; 16: 1

    Google Scholar 

  17. Horan J, Lederman J. Possible asthmogenic effect of oral contraceptives [letter]. Can Med Ass J 1968; 99: 130–1

    PubMed  CAS  Google Scholar 

  18. Collins L, Peiris A. Bronchospasm secondary to replacement estrogen therapy. Chest 1993; 104: 1300–2

    Article  PubMed  CAS  Google Scholar 

  19. Troisi RJ, Speizer FE, Willett WC, et al. Menopause, postmenopausal estrogen preparations, and the risk of adult-onset asthma. A prospective cohort study. Am J Respir Crit Care Med 1995; 152: 1183–8

    CAS  Google Scholar 

  20. Mirdal GM, Petersson B, Weeke B, et al. Asthma and menstruation: The relationship between psychological and bronchial hyperreactivity. BMJ Psychol 1998; 71: 47–55

    Google Scholar 

  21. Gluck JC, Gluck PA. The effects of pregnancy on asthma: a prospective study. Ann Allergy 1976; 37: 164–8

    PubMed  CAS  Google Scholar 

  22. Smith HR, Larsen GL, Cherniak RM, et al. Inflammatory cells and eicosanoid mediators in subjects with late asthmatic responses and increased airway responsiveness. J Allergy Clin Immunol 1992; 89: 1076

    Article  PubMed  CAS  Google Scholar 

  23. Koullapis E, Collins L. The concentration of 13-14-di-OH-15-OXO prostaglandin F2α in peripheral venous plasma throughout the normal ovarian and menstrual cycle. Acta Endocrinol (Copenh) 1980; 93: 123–8

    CAS  Google Scholar 

  24. Eliasson O, Longo M, Dore-Duffy P, et al. Serum 13-14-diOH-15-prostaglandin F2alpha and airway response to meclofenamate and metaproterenol in relation to the menstrual cycle. J Asthma 1986; 23: 309–19

    Article  PubMed  CAS  Google Scholar 

  25. Jeffery PK, Wardlaw AJ, Nelson F, et al. Bronchial biopsies in asthma. An ultrastructural, quantitative study and correlation with hyperreactivity. Am Rev Respir Med 1989; 140: 1745–53

    CAS  Google Scholar 

  26. American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease and asthma. Am Rev Respir Dis 1987; 136: 225–44

    Article  Google Scholar 

  27. Kirby JG, Hargreave FE, Gleich GJ, et al. Bronchoalveolar cell profiles of asthmatic and nonasthmatic subjects. Am Rev Respir Dis 1987; 136: 379–83

    Article  PubMed  CAS  Google Scholar 

  28. Kelly C, Ward C, Stenton CS, et al. Number and activity of inflammatory cells in bronchoalveolar lavage fluid in asthma and their relation to airway hyperresponsiveness. Thorax 1988; 43: 684–92

    Article  PubMed  CAS  Google Scholar 

  29. Juniper E, Frith P, Hargreave FE. Airway responsiveness to histamine and methacholine: relationship to minimum treatment to control symptoms of asthma. Thorax 1981; 36: 575

    Article  PubMed  CAS  Google Scholar 

  30. Tan KS, McFarlane LC, Lipworth BJ. Loss of normal cyclical β2-adrenoceptor regulation and increased premenstrual responsiveness to adenosine monophosphate in stable female asthmatic patients. Thorax 1997; 52: 608–11

    Article  PubMed  CAS  Google Scholar 

  31. Weinmann G, Zacur H, Fish J. Absence of changes in airway responsiveness during the menstrual cycle. J Allergy Clin Immunol 1987; 79: 634–8

    Article  PubMed  CAS  Google Scholar 

  32. Juniper E, Kline P, Roberts R, et al. Airway responsiveness to methacholine during the natural menstrual cycle and the effects of oral contraceptives. Am Rev Respir Dis 1987; 135: 1039–42

    PubMed  CAS  Google Scholar 

  33. Pauli B, Reid R, Munt P, et al. Influence of the menstrual cycle on airway function in asthmatic and normal subjects. Am Rev Respir Dis 1989; 140: 358–62

    Article  PubMed  CAS  Google Scholar 

  34. Polosa R, Phillips GD, Rafakulasingham K, et al. The effect of inhaled ipratropium bromide alone and in combination with oral terfenadine on bronchoconstriction provoked by adenosine 5’-monophosphate and histamine in asthma. J Allergy Clin Immunol 1991; 87: 939–47

    Article  PubMed  CAS  Google Scholar 

  35. Dauletbaev N, Gorijatchkina L, Ametov A, et al. Pulmonary function and bronchial hyperresponsiveness in various phases of the menstrual cycle. Am J Respir Crit Care Med 1996; 153: A515

    Google Scholar 

  36. Kharitonov S, Yates D, Robbins R, et al. Increased nitric oxide in exhaled air of asthmatic patients. Lancet 1994; 343: 133–5

    Article  PubMed  CAS  Google Scholar 

  37. Kharitonov S, Logan-Sinclair R, Busset C, et al. Peak expiratory nitric oxide differences in men and women: relation to the menstrual cycle. Br Heart J 1994; 72: 243–5

    Article  PubMed  CAS  Google Scholar 

  38. Kalogeromitros D, Katsarou A, Armenaka M, et al. Influence of the menstrual cycle on skin-prick test reactions to histamine, morphine and allergen. Clin Exp Allergy 1995; 25: 461–6

    Article  PubMed  CAS  Google Scholar 

  39. Kalsner S. Steroid potentiation of responses to sympathomimetic amines in aortic strips. Br J Pharmacol 1969; 40: 582–93

    Article  Google Scholar 

  40. Foster P, Goldie R, Paterson J. Effect of steroids on β-adrenoceptor mediated relaxation of pig bronchus. Br J Pharmacol 1983; 78: 441–5

    Article  PubMed  CAS  Google Scholar 

  41. Johansson S, Hjalmarson A. Age and sex differences in cardiovascular reactivity to adrenergic agonists, mental stress and isometric exercise in normal subjects. Scand J Clin Invest 1988; 48: 183–91

    PubMed  CAS  Google Scholar 

  42. Rahman A, McDevitt D, Struthers A, et al. Sex differences in hypokalaemic and electrocardiographic effects of inhaled terbutaline. Thorax 1992; 47: 1056–9

    Article  PubMed  CAS  Google Scholar 

  43. Wheeldon N, Newnham D, Coutie W, et al. Influence of sex-steroid hormones on the regulation of lymphocyte β2-adrenoceptors during the menstrual cycle. Br J Clin Pharmacol 1994; 37: 583–8

    Article  PubMed  CAS  Google Scholar 

  44. Tan KS, McFarlane LC, Coutie WJ, et al. Effects of exogenous female sex-steroid hormones on lymphocyte β2-adrenoceptors in normal females. Br J Clin Pharmacol 1996; 41: 414–6

    Article  PubMed  CAS  Google Scholar 

  45. Tan KS, McFarlane LC, Lipworth BJ. Paradoxical down-regulation and desensitisation of β2-adrenoceptors by exogenous progesterone in female asthmatics. Chest 1997; 111: 847–51

    Article  PubMed  CAS  Google Scholar 

  46. Chandler MMH, Schuldheisz S, Phillips BA, et al. Premenstrual asthma: the effect of estrogen on symptoms, pulmonary function and β2-receptors. Pharmacotherapy 1997; 17: 224–34

    PubMed  CAS  Google Scholar 

  47. British Thoracic Society. The British guidelines on asthma management. 1995 review and position statement. Thorax 1997; 52 Suppl. 1: S1–S21

    Article  Google Scholar 

  48. Wells AU, Chung KF. Corticosteroid induced osteoporosis in severe menstrual asthma. BMJ 1992; 305: 413–5

    Article  PubMed  CAS  Google Scholar 

  49. Beynon H, Garbett N, Barnes PJ. Severe premenstrual exacerbations of asthma. Effect of intramuscular progesterone. Lancet 1988; 2: 370–2

    CAS  Google Scholar 

  50. Myers JR, Sherman CB. Should supplemental estrogens be used as steroid-sparing agents in asthmatic women? Chest 1994; 106: 318–9

    Article  PubMed  CAS  Google Scholar 

  51. Tan KS, McFarlane LC, Lipworth BJ. Modulation of airway reactivity and diurnal peak flow variability in asthmatics receiving the oral contraceptive pill. Am J Respir Crit Care Med 1997; 155: 1273–7

    PubMed  CAS  Google Scholar 

  52. Blumenfeld Z, Bentur L, Yoffe N, et al. Menstrual asthma: use of a gonadotrophin-releasing hormone analogue for the treatment of cyclic aggravation of bronchial asthma. Fertil Steril 1994; 62: 197–200

    PubMed  CAS  Google Scholar 

  53. Murray Rd, New JP, Barber PV, et al. Gonadotrophin-releasing hormone analogues: a novel treatment for premenstrual asthma. Eur Respir J 1999; 14: 966–7

    Article  PubMed  CAS  Google Scholar 

  54. Ensom MHH, Chong E, Carter D. Premenstrual symptoms in women with premenstrual asthma. Pharmacotherapy 1999; 19: 374–82

    Article  PubMed  CAS  Google Scholar 

  55. Eliasson O, Densmore M, Scherzer H, et al. The effect of sodium meclofenamate in premenstrual asthma: a controlled clinical trial. J Allergy Clin Immunol 1987; 79: 909–18

    Article  PubMed  CAS  Google Scholar 

  56. Matsuo N, Shimoda T, Matsuse H, et al. A case of menstruation-associated asthma. Treatment with oral contraceptives. Chest 1999; 116: 252–3

    CAS  Google Scholar 

  57. Derimanov GS, Oppenheimer J. Exacerbation of premenstrual asthma caused by an oral contraceptive. Ann Allergy Asthma Immunol 1998; 81: 243–6

    Article  PubMed  CAS  Google Scholar 

  58. Mann JS, Holgate ST. Specific antagonism of adenosine-induced bronchoconstriction in asthma by oral theophylline. Br J Clin Pharmacol 1985; 19: 685–92

    Article  PubMed  CAS  Google Scholar 

  59. Richards R, Simpson SF, Renwick AG, et al. Inhalation rate of sodium cromoglycate determines plasma pharmacokinetics and protection against AMP-induced bronchoconstriction in asthma. Eur Respir J 1988; 1: 896–901

    PubMed  CAS  Google Scholar 

  60. Summers QA, Honeywell R, Renwick AG, et al. The protective efficacy of inhaled, oral and intravenous nedocromil sodium against adenosine-5-monophosphate induced bronchoconstriction in asthmatic volunteers. Pulmon Pharmacol 1990; 3: 190–7

    Article  CAS  Google Scholar 

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No funding was received to assist in the preparation of this manuscript, and there are no potential conflicts of interest.

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  1. Wishaw General Hospital, 50 Netherton Road, Wishaw, ML2 0DP, Scotland

    Kia Soong Tan

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Tan, K.S. Premenstrual Asthma. Drugs 61, 2079–2086 (2001). https://doi.org/10.2165/00003495-200161140-00005

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