Hormonal component to respiratory symptoms in women

Changes in respiratory symptoms in women may be governed partly by their menstrual cycles, research suggests.

"However, the pattern varied somewhat between the respiratory symptoms and differed between subgroups," write Ferenc Macsali (Haukeland University Hospital, Bergen, Norway) and co-workers in the American Journal of Respiratory and Critical Care Medicine.

They found that wheezing followed a distinct pattern, with two peaks on either side of the time of ovulation (days 14-16). There was a marked dip in symptoms around the time of ovulation and on each side of menses. Findings were similar for shortness of breath, except that the mid-cycle dip occurred slightly before ovulation.

The data came from 3926 women who were asked about their respiratory symptoms over the past 3 days and the date of the first day of their most recent menstrual bleed. In all, 5.6% reported wheezing, 1.8% shortness of breath, and 6.1% cough.

The patterns in wheezing and shortness of breath were consistent across most subgroups, although there was only a single peak, before mid-cycle, for wheezing in underweight women (body mass index <23 kg/m2) and for shortness of breath in women who were underweight, did not have asthma, and did not smoke.

"Cough showed distinct and more complicated patterns as compared to wheeze and shortness of breath, which seems plausible given the broader range of triggering factors, also including upper airways and remote triggers," comment Macsali et al.

Most women had a three-peaked pattern for cough, with peaks before and after ovulation and just before menses, but those with asthma had a two-peaked pattern, lacking the peak before menses. Women who were not underweight had the same pattern as asthmatics, whereas those who were underweight had a markedly different pattern, with peaks before and after menses and dips during and after ovulation.

The researchers say that the effect of body mass index supports a metabolic influence on respiratory symptoms.

The findings suggest that "adjustment of asthma medication to the menstrual cycle may prove feasible and efficient, but must be adapted on an individual basis," say Macsali and team. They advise physicians to ask women to record their symptoms over several cycles and to base treatment adjustments on the findings.

"Adjustment of asthma medication to the menstrual cycle may potentially improve the efficacy of asthma treatment and reduce disability and health costs related to asthma in women," they conclude.

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