CLINICAL DIFFERENCES AMONG WOMEN WITH AND WITHOUT SELF-REPORTED PERIMENSTRUAL ASTHMA

Background: Studies suggesting that 30% to 40% of asthmatic women repo rt significant perimenstrual (late luteal phase) exacerbations of asth ma are primarily retrospective, rely on subjective findings and do not demonstrate a consistent association between asthma and the menstrual cycle. Objective: In this exploratory analysis, women with and withou t self-reported perimenstrual exacerbations of asthma (PMA) were exami ned prospectively to determine the association between asthma and the menstrual cycle and to characterize associated clinical factors. Metho ds: Thirty-two adult asthmatic women with regular menstrual periods re corded daily asthma symptoms, medication use, and peak expiratory flow rate (PEFR) over six consecutive menstrual cycles, and underwent spir ometry and methacholine bronchoprovocation during the luteal and folli cular phases of 2 cycles. Results: Nine of 32 subjects (28.2%) reporte d PMA. Daily means of rescue medication use and AM peak flow computed for each perimenstrual day demonstrated significant non-parallelism of group profiles; subjects with PMA had increasing inhaled short acting beta 2-agonist use and decreasing AM peak flow rates during the perim enstrual interval, Luteal-follicular phase differences in FEV, or meth acholine bronchoprovocation between the groups were not detected. Subj ects with PMA were older (P =.007), had longer duration of asthma (P = .039), and increased baseline asthma severity (P =.076) compared with subjects without PMA. Conclusion: The findings of this study suggest t hat women with self-reported perimenstrual asthma demonstrate perimens trual differences in rescue bronchodilator use and AM peak flow and ap pear to constitute a distinct subset of women with asthma who are olde r, have longer duration of asthma, and increased severity of asthma co mpared with women without self-reported perimenstrual asthma. These fa ctors identify women who require close monitoring of their asthma duri ng their menstrual cycles.