Newswise — Hormone fluctuations resulting from life cycle changes are a factor in higher rates of asthma, more frequent emergency department visits, and higher hospital admission rates in women than in men according to reports at the annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI) in Anaheim.
"Since we began observing a correlation between women's hormonal status and asthma symptom patterns, investigators are studying asthma incidence and mortality in relation to premenstrual and perimenstrual cycles," said Nancy K. Ostrom, M.D., at the University of California and the Allergy & Asthma Medical Group and Research Center in San Diego.
"Women between the ages of 20-50 years are more than three times as likely as men to be hospitalized with asthma despite comparable spirometry. Studies have demonstrated a relationship between asthma and the menstrual cycle, with 46 percent of women's hospital admissions perimenstrual, and up to 40 percent of women having premenstrual asthma symptoms," Dr. Ostrom said.
"As many as 8 percent of pregnant women have asthma. Women with asthma who are pregnant or are planning a pregnancy face unique concerns about controlling their asthma symptoms and regarding the safety of medications," she said.
Obesity, sedentary lifestyle and smoking are other factors potentially contributing to the gender difference in asthma morbidity and mortality according to Dr. Ostrom.
"When we look at the reproductive phases of a woman's life cycle, we find in children under age 12, asthma is more common in boys than in girls. Around puberty the ratio changes, with asthma becoming more common in girls than in boys. Asthma is three times more common in women than in men," said Joan Gluck, M.D., at the Florida Center for Allergy and Asthma Care in Miami.
"Women with asthma experience more symptoms during their premenstrual and menstrual weeks with peak symptoms two to three days before menses. Many are not aware of this pattern, and keeping a diary of their symptoms is very helpful," she said.
Most premenstrual asthma patients respond to standard therapy. Some need increased inhaled corticosteroids or long-acting beta-agonist (LABA) on days 19-4 of their cycle. A small subset of women are unresponsive to the usual therapy. Oral contraceptives have been shown to have an impact on asthma.
"Nonasthmatic women on oral contraceptives have a higher total lung capacity. Airways are more stable in women with asthma who take oral contraceptives, and several small studies have shown their asthma does improve," Dr. Gluck said.
A correlation with higher asthma rates has also been noted in menopause and perimenopause, occurring prior to final menstrual cycle.
"Hormone replacement therapy (HRT) has different effects on asthma for different groups. Nonasthmatic women taking HRT have a higher risk of developing asthma. However, asthmatic women significantly improve on HRT, with studies showing as much as a 35 percent reduction in the use of inhaled steroids," Dr. Gluck said. Asthma complicates up to 8 percent of pregnancies and may increase the risk of perinatal complications according to Michael Schatz, M.D., M.S., at Kaiser-Permanente Medical Center in San Diego, Calif.
When women with asthma become pregnant, a third of the patients improve, one third worsen, and the last third remain unchanged. Asthma exacerbations are most likely to appear during the weeks 24 to 36 of gestation, with only a small minority of patients (20 percent or fewer) becoming symptomatic during labor and delivery.
"Patients with more severe asthma prior to pregnancy may be more likely to worsen during pregnancy. Uncontrolled asthma may increase the risk of perinatal mortality, low birth weight infants, preterm births and preeclampsia," Dr. Schatz said.
Management of asthma during pregnancy includes assessment and monitoring; reduction of triggers, patient education and pharmacologic therapy. Optimal management of asthma during pregnancy minimizes the risks, and improves maternal and fetal outcomes. Poor asthma control is the major risk to the health of the mother and fetus.
"A recent study demonstrated that asthma may be under-treated in women who are pregnant and who are contemplating pregnancy. For patients using inhaled corticosteroidc (ICS) before pregnancy, the rate of asthma-related physician visits decreased and the number of emergency department (ED) visits was unchanged after pregnancy. Physician and ED visits increased after pregnancy for patients not using an ICS before pregnancy," Dr. Schatz said.
According to recent National Asthma Education and Prevention Program guidelines, ICS are recommended as the controller therapy of choice for all levels of persistent asthma during pregnancy. Because of more reassuring data, inhaled budesonide is the preferred ICS for use during pregnancy, although other ICS may be continued in patients well-controlled on them prior to pregnancy.
Medications to be avoided during pregnancy include epinephrine (except for anaphylaxis), iodides, certain antibiotics, prostaglandin F2 analogues, ergonavine, and methylergonavine
"Although the outcome of any pregnancy can never be guaranteed, most women with asthma and allergies do well with proper medical management by physicians familiar with these disorders and the changes that occur during pregnancy," Dr. Schatz said.
More information on allergic diseases including asthma is available by calling the ACAAI toll-free number at 800-842-7777 or visiting its Web site at http://www.acaai.org.
The ACAAI is a professional medical organization, headquartered in Arlington Heights, Ill., comprising nearly 5,000 qualified allergists-immunologists and related health care professionals. The College is dedicated to the clinical practice of allergy, asthma and immunology through education and research to promote the highest quality of patient care.
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