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Original Research: Asthma |

Characteristics of Perimenstrual Asthma and Its Relation to Asthma Severity and ControlCharacteristics of Perimenstrual Asthma: Data From the Severe Asthma Research Program

Chitra K. Rao, MD; Charity G. Moore, PhD, MSPH; Eugene Bleecker, MD, FCCP; William W. Busse, MD; William Calhoun, MD, FCCP; Mario Castro, MD, FCCP; Kian Fan Chung, MD; Serpil C. Erzurum, MD; Elliot Israel, MD, FCCP; Douglas Curran-Everett, PhD; Sally E. Wenzel, MD, FCCP
Author and Funding Information

From the Division of Pulmonary, Allergy, and Critical Care Medicine (Drs Rao, Moore, and Wenzel), Department of Medicine, The University of Pittsburgh Asthma Institute @UPMC and the University of Pittsburgh School of Medicine, Pittsburgh, PA; Division of Pulmonary, Critical Care, Allergy, and Immunologic Medicine (Dr Bleecker), Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Division of Allergy and Clinical Immunology (Dr Busse), Department of Medicine, University of Wisconsin-Madison, Madison, WI; Division of Allergy, Pulmonary, Immunology, Critical Care, and Sleep (Dr Calhoun), Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX; Division of Pulmonary & Critical Care Medicine (Dr Castro), Department of Medicine, Washington University in St Louis, St Louis, MO; Division of Respiratory Medicine (Dr Chung), Department of Internal Medicine, Faculty of Medicine, Imperial College London, London, England; Department of Pathobiology (Dr Erzurum), Cleveland Clinic, Cleveland, OH; Division of Pulmonary and Critical Care (Dr Israel), Department of Medicine, Brigham and Women’s Hospital, Boston, MA; and Division of Biostatistics (Dr Curran-Everett), Department of Preventive Medicine and Biometrics and Department of Physiology and Biophysics, University of Colorado Denver and National Jewish Health, Denver, CO.

Correspondence to: Sally E. Wenzel, MD, FCCP, Pulmonary, Allergy, and Critical Care Medicine, The University of Pittsburgh Asthma Institute @UPMC and the University of Pittsburgh School of Medicine, NW 931 Montefiore Hospital, 3459 Fifth Ave, Pittsburgh, PA 15213; e-mail: wenzelse@upmc.edu


Funding/Support: This work was supported by the National Institutes of Health [Grants HL69116, HL69130, HL69155, HL69167, HL69170, HL69174, HL69349, HL091762, KL2RR025009, M01 RR02635, M01 RR03186, M01 RR007122-14, 1UL1RR024153, 1UL1RR024989, 1UL1RR024992, 1UL1RR025008, and 1UL1RR025011].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(4):984-992. doi:10.1378/chest.12-0973
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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.

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