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Hormones are not Janice Wilcox’s favoritesubject. Three years ago, the 49-year-oldmarketing manager from Chicago, Ill.,began experiencing irregular periods, hotflashes, night sweats, irritability, and

weight gain. Shortly afterward, her physician diagnosedher as experiencing perimenopause, the period of timeleading up to menopause.

“Yippee!” Janice exclaims sarcastically about her firstreaction to the diagnosis. “It was 10 degrees outside andI was walking down the street fanning myself to cooloff, so I wasn’t surprised.”

At the same time, Janice slowly began to realizethat her asthma, which had been under control formore than a decade, was getting worse. “I was usingmy rescue inhaler more often than I had in years,”she says. “I thought about it once in a while, butthere were so many other things going on that it tooka while to for me figure out what was happening.”

It turns out that what was happening to Janice isnot unusual.

Boys, Girls, and AsthmaAlthough boys start out life with higher rates of

asthma than girls, by the age of 12, the average age ofthe onset of puberty, girls take the lead and keep it for

life. The number of women with asthma increaseswith age. Women experiencing perimenopause andmenopause have higher asthma rates than women inother age groups.

Asthma results in more emergency room visits andhospital stays for women than men. Women also havemore severe asthma attacks than men with similarlung function test readings. As a result, asthma ismore lethal for women. The death rate from asthmafor women 35 to 64 years old is 22.3 per million,compared to 13 per million for men. For women 65years and older, the rate is 99.1 per million comparedto 68.1 per million for men.

For years, the question tugging at researchers was whywomen are affected by asthma in greater numbers andsuffer greater health complications than men. Today,many scientists believe they are unraveling the mystery. Agrowing body of research points to unexpected waysestrogen and progesterone impact asthma and allergies.

The Hormone ConnectionJoan Gluck, MD, an allergist and researcher at the

Florida Center for Allergy and Asthma Care inMiami, Fla., says fluctuations in hormone levels canhave complex, and not completely understood, effectson the body.

By Gregory Alford

HORMONES

Unmasking the Role of

in Asthma

Estrogen and ProgestroneMay Affect Asthma

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“We know that both estrogen and progesteronerelax smooth muscle tissue in the lungs and increasethe strength of the respiratory muscle,” says Dr.Gluck. “These hormones tend to have protectiveeffects for many women. They help prevent the con-striction of the airways related to asthma and allergysymptoms.”

Estrogen and progesterone also reduce lung inflam-mation by stimulating the immune response. In somewomen, the result is fewer asthma and allergy symp-toms when their hormone levels are high, explainsDr. Gluck. Oral contraceptives improve the lungcapacity of women with no asthma. Several smallstudies show that women diagnosed with asthma whotake oral contraceptives have more stable airways andreport fewer asthma symptoms.

In females, almost half of asthma-related hospitaladmissions take place within a week of their period, and25% occur one day before the start of menstruation,says Dr. Gluck. Most of those women report takingincreasing amounts of asthma medications during theprevious week.

A study published in the journal Thorax of more than8500 northern European women who have irregularperiods found that they reported significantly higherrates of asthma and allergy than those with regular peri-ods (2005;60:445-60).

“Women with asthma experience more symptomsduring their premenstrual and menstrual weeks withpeak symptoms two to three days before menses(when hormone levels are low),” says Dr. Gluck.“Most premenstrual asthma patients respond to stan-dard therapy. Some need increased inhaled corticos-teroids or long-acting beta-agonists on days 1-4 oftheir cycle. However, a small subset of women doesnot respond to normal asthma therapies.”

Dr. Gluck recommends that asthmatic women keepa diary to track when they are having symptoms andshare the information with their physician. She addsthat women should share with their physician what partof their menstrual cycle they are in when they undergoa lung function test.

Pregnancy and Asthma Nancy K. Ostrom, MD, an assistant clinical professor

at the University of California in San Diego, and in pri-vate practice at the Allergy & Asthma Medical Groupand Research Center in San Diego, Calif., says womenwho are or want to be pregnant should discuss asthmacontrol issues with their physician.

“As many as eight percent of pregnant women haveasthma. Women with asthma who are pregnant or areplanning a pregnancy face unique concerns aboutcontrolling their asthma symptoms and issues regard-ing the safety of medications,” says Dr. Ostrom.

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The National Asthma Education and PreventionProgram, created by the National Institutes of Health(NIH), reports that about one-third of pregnant asth-matics find their asthma improves, another one-thirdgets worse, and the final third experiences little or nochange. Asthma symptoms are most likely to increasebetween 24 and 36 weeks of gestation.

There are risks associated with maternal asthma. Astudy published in the Journal of Maternal-Fetal andNeonatal Medicine found that asthma increased the rateof cesarean deliveries, as well as the risk of complica-tions associated with diabetes, hypertensive disorders,and intrauterine growth restriction (2005;18:237-40).

“A recent study demonstrated that asthma may beunder-treated in women who are pregnant or who arecontemplating pregnancy. Patients with more severeasthma prior to pregnancy may be more likely tohave their asthma worsen during pregnancy,” saysMichael Schatz, MD, of Kaiser-Permanente MedicalCenter in San Diego. “Although the outcome of anypregnancy can never be guaranteed, most womenwith asthma and allergies do well with proper med-ical management by physicians familiar with thesedisorders.”

Management of asthma during pregnancy includesassessment and monitoring, reducing exposure to envi-ronmental asthma triggers, education, and the propercombination of medications.

More is Not Always BetterIf low levels of estrogen and progesterone contribute

to asthma and allergies in some women, and higher lev-els seems to offer protection, then it makes sense thathormone replacement therapy (HRT) should be pre-scribed. Not so fast, says Dr. Gluck, who has publishedasthma research for 30 years.

HRT has different effects on asthma for differentgroups of people. Nonasthmatic women taking HRThave a significantly increased risk of developing asthma,says Dr. Gluck. However, asthmatic women significant-ly improve on HRT, with studies showing as much as a35% reduction in the use of inhaled corticosteroids.

“This is a fairly new area of research so it is going totake some time to sort out who benefits from HRT,who does not, and why,” says Dr. Gluck.

Several months after her perimenopause diagnosis,Janice Wilcox talked to her physician about her newlydifficult to control asthma. Her physician suggestedHRT to control her asthma and other perimenopausesymptoms. Although there are health risks associatedwith HRT, Janice felt going on the medication was theright decision for her.

“I am happy with the results. After two months ofhormone replacement therapy I was able to almost stopusing my rescue inhaler,” says Janice. “It was nice to getoff the hormonal rollercoaster and get on with my life.”

Gregory Alford is a freelance writer and health columnistfor several newspapers in Illinois.

Reprint orders: Elsevier Inc., 11830 Westline Industrial Dr.,St. Louis, MO 63146-3318; phone: 314-453-4350.doi:10.1016/j.asthmamag.2005.12.005

National Institutes of HealthManaging Asthma DuringPregnancy report:www.nhlbi.nih.gov/health/prof/lung/asthma/astpreg.htm.

American Academy of Allergy,Asthma and ImmunologyAsthma and Pregnancy Tips:www.aaaai.org/patients/publicedmat/tips/asthmaandpregnancy.stm

More Information onthe Web:

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