Chest
Volume 143, Issue 4, April 2013, Pages 984-992
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Original Research
Asthma
Characteristics of Perimenstrual Asthma and Its Relation to Asthma Severity and Control: Data From the Severe Asthma Research Program

https://doi.org/10.1378/chest.12-0973Get rights and content

Background

Although perimenstrual asthma (PMA) has been associated with severe and difficult-to-control asthma, it remains poorly characterized and understood. The objectives of this study were to identify clinical, demographic, and inflammatory factors associated with PMA and to assess the association of PMA with asthma severity and control.

Methods

Women with asthma recruited to the National Heart, Lung, and Blood Institute Severe Asthma Research Program who reported PMA symptoms on a screening questionnaire were analyzed in relation to basic demographics, clinical questionnaire data, immunoinflammatory markers, and physiologic parameters. Univariate comparisons between PMA and non-PMA groups were performed. A severity-adjusted model predicting PMA was created. Additional models addressed the role of PMA in asthma control.

Results

Self-identified PMA was reported in 17% of the subjects (n = 92) and associated with higher BMI, lower FVC % predicted, and higher gastroesophageal reflux disease rates. Fifty-two percent of the PMA group met criteria for severe asthma compared with 30% of the non-PMA group. In multivariable analyses controlling for severity, aspirin sensitivity and lower FVC % predicted were associated with the presence of PMA. Furthermore, after controlling for severity and confounders, PMA remained associated with more asthma symptoms and urgent health-care utilization.

Conclusions

PMA is common in women with severe asthma and associated with poorly controlled disease. Aspirin sensitivity and lower FVC % predicted are associated with PMA after adjusting for multiple factors, suggesting that alterations in prostaglandins may contribute to this phenotype.

Section snippets

Population and Subject Characterization

Subjects were part of SARP, the details of which have been previously described.10 Severe asthma was defined by the 2000 American Thoracic Society workshop criteria, with a combination of one of two major and two of seven minor criteria.12 All other subjects with asthma enrolled in SARP were termed “not severe” as detailed by Moore et al.10 All subjects completed questionnaires on a range of topics. Pulmonary function testing was performed according to American Thoracic Society guidelines as

Baseline Characteristics

Of the 756 female subjects enrolled into SARP, those aged < 12 years (n = 47) and > 50 years (n = 146) were excluded from analysis. In the remaining 563, 14% (n = 80) did not know whether menses exacerbated their asthma and were eliminated from further analysis, suggesting that most subjects could answer the question. Ultimately, 483 subjects were included in this analysis. Women unable to answer the PMA question (e-Tables 1, 2) generally had a more severe condition but did not differ in other

Discussion

It is increasingly clear that hormonal influences affect asthma phenotypes and severity. Although asthma is more common in boys, at the time of puberty and beyond, it becomes more common in girls and women.14 The subset of women with PMA remains poorly characterized. Definitions have differed across studies, and no large-scale analyses have been performed.15, 16 To this end, > 500 women with a range of asthma severity recruited for SARP were analyzed for PMA. The data from this largest study to

Acknowledgments

Author contributions: All the authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Rao: contributed to the data analysis and preparation and critical review of the manuscript.

Dr Moore: contributed to the data analysis and preparation and critical review of the manuscript.

Dr Bleecker: contributed to the study design, recruitment of participants, data acquisition, and preparation and critical review

References (35)

  • RL Sorkness et al.

    Sex dependence of airflow limitation and air trapping in children with severe asthma

    J Allergy Clin Immunol

    (2011)
  • JA Burgess et al.

    Factors influencing asthma remission: a longitudinal study from childhood to middle age

    Thorax

    (2011)
  • M Gaga et al.

    Risk factors and characteristics associated with severe and difficult to treat asthma phenotype: an analysis of the ENFUMOSA group of patients based on the ECRHS questionnaire

    Clin Exp Allergy

    (2005)
  • M Romagnoli et al.

    Near-fatal asthma phenotype in the ENFUMOSA cohort

    Clin Exp Allergy

    (2007)
  • SE Wenzel

    A different disease, many diseases or mild asthma gone bad? Challenges of severe asthma

    Eur Respir J

    (2003)
  • BE Brenner et al.

    Relation between phase of the menstrual cycle and asthma presentations in the emergency department

    Thorax

    (2005)
  • M van den Berge et al.

    The role of female sex hormones in the development and severity of allergic and non-allergic asthma

    Clin Exp Allergy

    (2009)
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      Block of eNOS (genetic or pharmacologial) alleviated any differences in anaphylactic reaction. Moreover, there is a term of perimenstrual asthma (PMA) mentioned in the scientific literature, associated with cyclic loss of asthma control on initial days of menstruation [12]. In this article we present results of our study on atopy and allergic disorders in women treated for infertility of various aetiology.

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    Funding/Support: This work was supported by the National Institutes of Health [Grants HL69116, HL69130, HL69155, HL69167, HL69170, HL69174, HL69349, HL091762, KL2RR025009, M01 RR02635, M01 RR03186, M01 RR007122-14, 1UL1RR024153, 1UL1RR024989, 1UL1RR024992, 1UL1RR025008, and 1UL1RR025011].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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