A sthma is a complex disease with recognized sex differences. Adult asthma affects more women than men, and women may be predisposed to greater severity. [1][2][3][4] Additionally, women report onset of asthma later in life, often associated with times of hormonal change.In small studies, about 30% to 40% of women report worsening of asthma symptoms in relation to menstruation. [5][6][7][8] The presence of perimenstrual asthma (PMA) has been related to increases in asthmarelated ED visits, hospitalizations, ICU admissions, intubations, and near-fatal and fatal events. 5 Unfortunately, the small nature of previous studies limits the ability to characterize contributing factors or implications of PMA.There is growing support for the concept that asthma consists of multiple phenotypes, which may be more easily recognized in severe asthma. 9,10 Although the National Heart, Lung, and Blood Institute Severe Asthma Research Program (SARP), a large network to study severe asthma mechanisms, recently identifi ed a female-predominant, late-onset phenotype, 11Background: Although perimenstrual asthma (PMA) has been associated with severe and diffi cultto-control asthma, it remains poorly characterized and understood. The objectives of this study were to identify clinical, demographic, and infl ammatory 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, immunoinfl ammatory 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-identifi ed PMA was reported in 17% of the subjects (n 5 92) and associated with higher BMI, lower FVC % predicted, and higher gastroesophageal refl ux 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.
CHEST 2013; 143(4):984-992Abbreviations: F eno 5 fraction of exhaled nitric oxide; GERD 5 gastroesophageal refl ux disease; HCU 5 health-care utilization; PG 5 prostaglandin; PMA 5 perimenstrual asthma; SARP 5 Severe Asthma Research Program
