Airway Inflammation in Premenstrual Asthma

Abstract

Premenstrual asthma (PMA) is a clinical picture with worsening of asthmatic symptoms and pulmonary functions in the late luteal phase of the menstrual cycle. The aim of this study was to evaluate the inflammatory changes in asthmatic women who complain of PMA. Forty asthmatic women attending our outpatient clinic were questioned about worsening of their asthma before menstruation. Eleven women (aged 17-40) who complained of PMA participated in the study. Subjects were asked to record peak expiratory flow rates, symptom scores, and beta-agonist use daily. After the first menses on the seventh day of their cycle, and before the onset of the next menstruation, on the 26+/-3rd day of the cycle, patients were evaluated with pulmonary function tests, methacholine challenge test, and fractionated exhaled nitric oxide (FE(NO)) levels. Eosinophils in peripheral blood and induced sputum were also evaluated. When comparing the two groups of results, the significant changes were in FENO levels, day-time symptom scores, and eosinophils in induced sputum (29.25 ppb/9.16 ppb p < 0.05, 1/0.45 p = 0.05, %6.63/%4.09 p < 0.01, respectively, before and after menstruation). These results show that PMA is not only a clinical picture with a decrease in airway calibre that can be related to the regulation of 2 receptors, but also a complex state with worsening of airway inflammation.

Serum estradiol concentration, estradiol-toprogesterone ratio and sputum IL-5 and IL-8 concentrations are increased in luteal phase of the menstrual cycle in perimenstrual asthma patients

“…A larger number of PMA patients could perhaps reveal significant correlation between the two indicators. The obtained results are consistent with the conclusions of some former studies (43,44) in which the enhanced local airway inflammation reaching its maximum shortly before menstruation has also been demonstrated. Progesterone acts via two main receptors (PR-A and PR-B) present on airway epithelial cells, activation of which has been shown to reduce cilia beat frequency by 40-50% (45).…”

Risk Factors for Frequent Asthma Exacerbation in Japanese Patients with Refractory Asthma

“…In addition, the few small studies that have been performed suggest an increase in in ammation before menstruation in susceptible women 27 .…”

Measurement of Exhaled Nitric Oxide

“…Kompartman modelinin kullanıldığı ilk araştırmaların sonuçlarında steroid almayan astımlılarda havayolu NO akışı artmış, alveolar NO'in normal olduğu gözlenmiştir [36,37]. Daha sonra yapılan çalışmalarda havayolu NO akışındaki artışa ek olarak nokturnal semptomu olan astımlılarda alveolar NO konsantrasyonu da yüksek bulunmuş ve bu durum daha periferal inflamasyon ve nötrofilik aktivasyonla ilişkilendirilmiştir [38] [17,27,40]. Ölçümden hemen önce yeşil salata gibi nitrat içeren yiyeceklerin tüketilmesi, kafeinli, alkollü içeceklerin tüketilmesi ve su içilmesi geçici olarak NO ölçümünü etkileyebileceği gösterilmiştir.…”

“…Steroid tedavisi almamış astımlı hastalarda sağlıklı kişilere göre FE NO değerlerinin yüksek olduğu pek çok çalışma ile gösterilmiştir [6,[8][9][10][11][12]. Astım atakların-da, kontrol altında olmayan astımda, steroide dirençli astım olgularında ve antiinflamatuar ilaç dozunun azaltıldığı olgularda FE NO düzeylerinin yüksek bulunduğu gösterilmiştir [13][14][15][16][17]. FE NO 'in astım aktivitesini göstermede ECP veya soluble interlökinler gibi diğer serum belirteçlerinden daha duyarlı bir yöntem olduğu, inflamatuvar hücre yoğunluğu-nu yansıttığı gösterilmiştir [16,18].…”