Up to 40% of women with bronchial asthma note an increase in the frequency and severity of seizures before and during menstruation. Gibbs et al. objectively confirm the premenstrual deterioration of the patient’s condition, citing documented evidence of a decrease in the maximum volumetric expiratory flow rate. There is also some evidence that in the premenstrual period, women are more likely to need hospitalization for asthma complications, including respiratory failure.
The exact etiology of premenstrual asthma is still unknown, but there are suggestions about its dependence on changes in the amount of progesterone or prostaglandins. After ovulation, the progesterone content constantly increases, and then sharply decreases several days before menstruation. Progesterone has a relaxing effect on smooth muscles and, thus, can affect the cyclical changes in the sensitivity of the respiratory tract. Stimulation of hyperventilation can then lead to increased symptoms of asthma and dyspnea.
In women with premenstrual asthma , both a subjective increase in asthma symptoms and an objective increase in peak volume expiratory flow rate are noted, however, a simultaneous deterioration in airway reactivity has not been proven. There was also no association between respiratory function and absolute progesterone levels.
Although some prostaglandins stimulate bronchospasm , studies have not shown a correlation between the synthesis of endogenous prostaglandias and premenstrual asthma. There are suggestions of immune disorders associated with the menstrual cycle. According to researchers, the development of premenstrual asthma may be partially associated with increased attention to asthma symptoms, which may be due to PMS. In addition, the relationship of premenstrual asthma, PMS symptoms, and dysmenorrhea has been shown.
Both estrogens and progesterone can alter the functions and regulation of b2-adrenergic receptors, enhancing the bronchodilator effect of catecholamines. In healthy women, cyclic changes in b2-adrenergic receptors occur during the menstrual cycle with an increase in their sensitivity in the luteal phase, which is most likely associated with the action of progesterone. It is interesting to note that these cyclic changes are absent in women with asthma who have a paradoxical decrease in sensitivity when taking progesterone.
Changes in the function and regulation of b2-adrenergic receptors can lead to a decrease in response to both endogenous and exogenous bronchodilators, causing exacerbations of premenstrual asthma.
Premenstrual Asthma Treatment
Accurate diagnosis is needed to properly treat premenstrual asthma . A detailed description of the period of exacerbations, as well as patient diary entries, fixing symptoms, and maximum volume expiratory flow rate may be useful here. Most women feel an improvement in taking high doses of conventional anti-asthma drugs (b-adrenergic receptor agonists, anticholinergics, and glucocorticoids) during the luteal phase.
In three women with severe persistent premenstrual asthma, intramuscular administration of progesterone gave a good effect, eliminating the decrease in the maximum volumetric expiratory flow rate and also reducing the need for systemic glucocorticoids. A randomized clinical trial did not confirm the relief of severe premenstrual asthma with exogenous estradiol.
Two studies have shown the successful use of luliberin agonists for the treatment of recurrent menstruation-related asthmatic status. Improving well-being as a result of taking high doses of progesterone and luliberin agonists may be due to the fact that as a result of their influence, the synthesis of ovarian hormones is suppressed. Although there has previously been interest in the use of oral contraceptives in the treatment of premenstrual asthma, studies have shown greater variability in their effectiveness in asthma symptoms.