Many articles have identified the disproportionate level of severe and fatal asthma in subgroups of people in this country (such as African Americans and Hispanics of Puerto Rican descent). Were you aware that adult women have higher severity levels and risks of death from asthma compared to adult males?
Women have unique vulnerabilities to asthma that only become evident after puberty. They suffer more severe episodes and have different patterns of asthma symptoms thought to be related to hormones and their reproductive system.
Interestingly, the severity of asthma and mortality rate of asthma is higher in young males compared to young females but older aged females surpass the men in both categories. This pubertal switch in asthma severity coincides with when women are making more estrogen and begin to have fluctuating levels of this female hormone (the menstrual cycle). Some researchers think the fluctuation in estrogen hormone is the key factor in promoting more inflammation in the lungs.
Some of my adult female asthma patients report that they have more shortness of breath and wheezing within a few days of the start of their menstrual cycle. This pattern of premenstrual asthma has been reported in many respiratory review articles. Some younger females experience their first asthma attacks shortly after the start of menstruation. Women are more often hospitalized for asthma attacks around the time of menstruation.
You might ask: What is the connection between female hormones and asthma?
All the answers are not available but some researchers report that shifts in the levels of female hormones over time, and in certain circumstances, may lead to worsening asthma. Here are some circumstances:
The estrogen level drops to a very low level just before the period starts. This change may be a key factor in triggering, or lowering the threshold for asthma to be triggered. Not all women experience worsening asthma for unexplained reasons. There is much more to be learned about asthma in this area.
The physiologic changes and swings in hormones that take place in pregnancy are unsurpassed by any other life processes. For twenty years I have oriented my newly pregnant asthma patients to the three possible experiences they may have. A third of pregnant women with a history of asthma may experience worsened control. Another third may have no change in their asthma status. The last third may actually have improved asthma control and require less medication. Which impact pregnancy will have on asthma is totally unpredictable.
You would think, based on the above information, that when menstruation stops, later in life (menopause), asthma would improve. But you would be wrong. Menopause is another time in a woman's life when hormones go through greater levels of fluctuation. Estrogen levels often plummet to very low levels. Again, this change in hormone level appears to be the factor, not the actual level of the hormone at a given time. Some of my most difficult to control asthma patients are women that are at this point in their life.
What Can You Do?
-If you recognize a pattern of asthma worsening that coincides with your menstrual cycle talk to your doctor about managing you controller medications accordingly.
-Find out whether you have allergy triggers in order to aggressively avoid them, especially at time in the month when you may be more susceptible to them.
-If you are on birth control pills have your asthma care provider work with your gynecologist to establish a regimen that might be better suited for managing menstrual associated asthma symptoms.
-If you are or intend to get pregnant see about getting a consultation with an allergist in order to plan ahead, establish an action plan and system to monitor your asthma control
-Peri-menopausal (the time around menopause) women may have some benefit from hormone replacement but the risks and benefits need to be thoroughly reviewed by your doctor.
There is no existing subtype of asthma that cannot be better managed by the combination of education (learning more about asthma), environmental controls, medication adjustment, and adequate monitoring and follow-up.
Questions for the women:
Do you have more breathing problems at a certain time of your monthly cycle?
Did your asthma worsen at a certain age or after a certain point in your life?