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Communications to the Editor |

Perimenstrual Asthma Exacerbations and Positioning of Leukotriene-Modifying Agents in Asthma Management Guidelines FREE TO VIEW

Norman L. Dean, MD, FCCP
Author and Funding Information

Chapel Hill, NC

Correspondence to: Norman L. Dean, MD, FCCP, PO Box 4886, Chapel Hill, NC 27515; e-mail: mgdeanesq@nc.rr.com



Chest. 2001;120(6):2116-2117. doi:10.1378/chest.120.6.2116-b
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To the Editor:

The excellent review in CHEST (May 2001) by Salvi et al,1discussing the combined anti-inflammatory and bronchodilating effects of leukotriene-modifying agents and their positioning in asthma management guidelines, is both timely and needed in updating guidelines for asthma therapy. Perimenstrual exacerbations of persistent asthma, in addition to exercise- and aspirin-induced asthma, is an example of a subset of asthma better controlled by the addition of a leukotriene-modifying agent to a regimen containing inhaled steroids. Forty percent of asthmatic female patients have perimenstrual exacerbations of asthma uncontrolled by steroid therapy.2Female asthmatics have an increase in bronchial reactivity to adenosine monophosphate and dysregulation ofβ 2-receptors concomitant with fluxes of estrogen and progesterone during the transition from the luteal to the follicular phase of the menstrual cycle.3 Studies25 have noted the inability of therapeutic steroids to inhibit clinical perimenstrual exacerbations of persistent asthma. The efficacy of leukotriene-modifying agents in preventing perimenstrual exacerbations and concomitant increases in leukotrienes have been cited in two reports.45 Additional studies examining the role of leukotriene-modifying agents in perimenstrual asthma exacerbations and on the neuroendocrine immune system are needed.

The combined anti-inflammatory and bronchodilating properties of leukotriene modifiers described by Salvi and colleagues1 highlight both the early (step 2) role for these controller agents as well as a role in all stages of severity of persistent asthma. Leukotriene modifiers, particularly in perimenstrual-, exercise-, and aspirin-triggered asthma and asthma with comorbid rhinitis, merit consideration as an addition to inhaled steroid therapy as a controller targeting inflammation not adequately controlled by steroids.

References

Salvi, SS, Krishna, MT, Holgate, S, et al (2001) The anti-inflammatory effects of leukotriene-modifying drugs and their use in asthma.Chest119,1533-1546
 
Skobeloff, EM, Spivey, WH, Silverman, R, et al The effect of the menstrual cycle on asthma presentations in the emergency department.Arch Intern Med1996;156,1837-1840
 
Tan, KS, McFarlane, LC, Lipworth, BJ Loss of normal cyclical β2-adrenoreceptor regulation and increased premenstrual responsiveness to adenosine monophosphate in stable female asthmatics.Thorax1997;52,608-611
 
Nakasato, H, Ohrui, T, Sekizawa, K, et al Prevention of severe premenstrual asthma attacks by leukotriene receptor antagonists.J Allergy Clin Immunol1999;104,585-588
 
Dean, N, Sadat, A, Nunnery, S, et al Montelukast provides superior efficacy for perimenstrual asthma exacerbations not controlled by inhaled steroids [abstract]. Chest. 2001;;120 ,.:208S
 

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References

Salvi, SS, Krishna, MT, Holgate, S, et al (2001) The anti-inflammatory effects of leukotriene-modifying drugs and their use in asthma.Chest119,1533-1546
 
Skobeloff, EM, Spivey, WH, Silverman, R, et al The effect of the menstrual cycle on asthma presentations in the emergency department.Arch Intern Med1996;156,1837-1840
 
Tan, KS, McFarlane, LC, Lipworth, BJ Loss of normal cyclical β2-adrenoreceptor regulation and increased premenstrual responsiveness to adenosine monophosphate in stable female asthmatics.Thorax1997;52,608-611
 
Nakasato, H, Ohrui, T, Sekizawa, K, et al Prevention of severe premenstrual asthma attacks by leukotriene receptor antagonists.J Allergy Clin Immunol1999;104,585-588
 
Dean, N, Sadat, A, Nunnery, S, et al Montelukast provides superior efficacy for perimenstrual asthma exacerbations not controlled by inhaled steroids [abstract]. Chest. 2001;;120 ,.:208S
 
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