Characteristics of perimenstrual asthma and its relation to asthma severity and control: data from the Severe Asthma Research Program

Abstract

Background: Although perimenstrual asthma (PMA) has been associated with severe and difficult-to-control asthma, it remains poorly characterized and understood. The objectives of this study were to identify clinical, demographic, and inflammatory 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, immunoinflammatory 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-identified PMA was reported in 17% of the subjects (n = 92) and associated with higher BMI, lower FVC % predicted, and higher gastroesophageal reflux 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.

Figure 1.

Comparison of common asthma symptom frequency between subjects with PMA and subjects without PMA, adjusted for severity. Symptom scores are based on a six-point scale ranging from never to more than once daily. *P < .05. PMA = perimenstrual asthma.

Figure 2.

Frequency of health-care utilization unadjusted for severity between PMA and non-PMA groups. OR and 95% CI values are adjusted for severity. *Events reported in the 12 months prior to administration of questionnaire. #Events reported as lifetime history. OCS = oral corticosteroid. See Figure 1 legend for expansion of other abbreviation.