Abstract
Asthma is a frequent medical condition in adolescence. The worsening of the most common symptoms perimenstrually is defined as perimenstrual asthma (PMA). The cause of PMA remains unclear, but a role for hormonal milieu is plausible. Data on PMA in adolescents are limited, and its management is not fully established. We aimed to discuss the PMA phenomenon in young females from pathophysiology to preventive strategies, focusing on the relationship with the hormonal pattern. The fluctuation of estrogens at ovulation and before menstruation and the progesterone secretion during the luteal phase and its subsequent withdrawal seem to be the culprits, because the deterioration of asthma is cyclical during the luteal phase and/or during the first days of the menstrual cycle. Conventional asthma therapies are not always effective for PMA. Preventive strategies may include innovative hormonal contraception. Even a possible beneficial effect of other hormonal treatments, including estrogens, progestogens, and androgens, as well as leukotriene receptor antagonists and explorative approach using microbial-directed therapy, is considered. The underlying mechanisms, through which sex-hormone fluctuations influence asthma symptoms, represent a challenge in the clinical management of such a distressing condition. Further studies focused on young females are mandatory to promote adolescent health.
Highlights
Asthma is one of the commonest noncommunicable diseases; it is a frequent medical condition in childhood and adolescence, characterized by high prevalence, chronic nature, potentially severe symptoms, and associated burden on healthcare resources [1,2].The global prevalence of asthma is characterized by wide variability among countries: it is highest in developed countries and lowest in emerging ones; its burden is increasing rapidly in developing countries as lifestyles become more Westernized [3,4]
Asthma can worsen during the perimenstrual period, which is an event known as perimenstrual asthma (PMA)
Fluctuation of estrogens at ovulation and before periods, along with progesterone secretion during the luteal phase and its subsequent withdrawal, seem to be the culprits, because deterioration of asthma is cyclical during the luteal phase and/or during the first days of the menstrual cycle
Summary
Asthma is one of the commonest noncommunicable diseases; it is a frequent medical condition in childhood and adolescence, characterized by high prevalence (approximately 5–10%), chronic nature, potentially severe symptoms, and associated burden on healthcare resources [1,2].The global prevalence of asthma is characterized by wide variability among countries: it is highest in developed countries and lowest in emerging ones; its burden is increasing rapidly in developing countries as lifestyles become more Westernized [3,4]. Asthma is one of the commonest noncommunicable diseases; it is a frequent medical condition in childhood and adolescence, characterized by high prevalence (approximately 5–10%), chronic nature, potentially severe symptoms, and associated burden on healthcare resources [1,2]. Asthma is characterized by respiratory symptoms, such as coughing, wheezing, shortness of breath, chest tightness, and enhanced mucus production, that vary over time. It is usually associated with variable airflow limitation and hyper-responsiveness at lung function testing, and with markers of airways inflammation in some patients [2]. Fluctuation of estrogens at ovulation and before periods, along with progesterone secretion during the luteal phase and its subsequent withdrawal, seem to be the culprits, because deterioration of asthma is cyclical during the luteal phase and/or during the first days of the menstrual cycle
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