Perimenstrual Asthma

http://www.ncbi.nlm.nih.gov/pubmed/23197300

Chest. 2012 Nov 29. doi: 10.1378/chest.12-0973. [Epub ahead of print]

Characteristics of Perimenstrual Asthma (PMA) and its Relation to Asthma Severity and Control: Data from the Severe Asthma Research Program.

Rao1 CK, Moore1 CG, Bleecker2 E, Busse3 WW, Calhoun4 W, Castro5 M, Chung6 KF, Erzurum7 SC, Israel8 E, Curran-Everett9 D, Wenzel1 SE.

Abstract

ABSTRACT BACKGROUND:

Although perimenstrual asthma (PMA) has been associated with severe and difficult to control asthma, it remains poorly characterized and understood.

OBJECTIVES:

To identify clinical, demographic and inflammatory factors associated with PMA and to assess the association of PMA with asthma severity and control.

METHODS:

Female asthmatics, recruited to the National Heart, Lung and Blood Institute's Severe Asthma Research Program who reported PMA symptoms on a screening questionnaire, were analyzed in relation to basic demographics, clinical questionnaire data, immuno-inflammatory 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 women (n=92) and associated with higher body mass index, lower percent-predicted forced vital capacity (FVC%) and higher gastroesophageal reflux disease rates. Fifty-two percent of the PMA group met criteria for severe asthma, as compared to 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. Further, after controlling for severity and confounders, a history of PMA remained associated with more asthma symptoms and urgent healthcare utilization.

CONCLUSION:

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