围月经期哮喘诊治进展

一些支气管哮喘（简称哮喘）妇女在月经前或月经期哮喘症状可以加重，称之为月经前期哮喘或月经期哮喘，统称为围月经期哮喘。围月经期哮喘相当常见，大约占哮喘妇女的30％～40％。雌二醇、孕酮、阿司匹林、白三烯可能与其发病有关。根据月经前或月经期哮喘症状加重和呼气峰流速降低可以做出诊断。雌二醇、孕酮、白三烯调节剂可以用于围月经期哮喘的治疗。     

支气管哮喘妇女月经周期气道反应性的改变

通过对120例支气管哮喘妇女于月经周期利用组织胺为激发剂进行非特异性激发试验,以激发浓度PC_(20)-PEF、激发阈值PD_(20)-PEF、24小时波动率为观察指标,观察月经前期(月经前1周)、月经期、月经期后(月经后1周)的变化,发现支气管哮喘妇女月经期间PC_(20)-PEF、PD_(20)-PEF均低于月经前期及月经期后,月经前期低于月经期后,24小时PEF于月经期间波动率最大,其中有36例(30%)临床上有哮喘症状出现,通过观察说明妇女月经期间气道反应性增强,月经周期和支气管哮喘有密切关系。     

性激素周期性变化对哮喘发作的影响

目的 :探讨女性哮喘患者月经周期中性激素水平对哮喘发作的影响。方法 :选择女性支气管哮喘患者 40例分为 2组 ,A组为月经期哮喘发作或原有症状加重者 2 0例 ,B组为月经期无哮喘发作或原有症状无变化者 2 0例 ,健康工作人员 2 0例作为对照组C组。各组观察对象均于月经期及经后 1周测定雌二醇 (E2 )、孕酮 (P)、血栓素B2 (TXB2 )、6 酮 前列腺素F1a(6 k PGF1a)。结果 :A组月经期E2 、P最低水平时 ,呼气峰流速 (PEF)波动率 >2 0 % ,经后E2 、P恢复正常时PEF波动率 <2 0 %。A组经期TXB2明显高于经后期 ,经期 6 k PGF1a低于经后期。A组经期E2 、P、TXB2 、6 k PGF1a与B组、C组同期相应指标比较均有明显差异。B组与C组经期及经后 1周PEF波动率均小于 2 0 % ,2组月经期E2 、P、6 k PGF1a相比均无明显差异 (P >0 .0 5 ) ,经期后TXB2 有差异 ,(P <0 0 5 )。结论 :哮喘患者月经前后E2 、P的波动幅度与哮喘发作的程度有明显关系。     

月经性疾病的临床特点

月经性疾病的特点是发病与月经周期密切相关,症状及体征随月经停止而消失或减轻。临床虽常见,但早期误诊率较高,为引起临床医生重视,现将几种常见的月经性疾病和病征简述如下。1.月经性哮喘:常于月经期突然发生胸闷、咳嗽、哮喘,双肺可闻及哮鸣音,有的甚至呈哮喘持续状态,月经结束后哮喘消失。有学者认为本病与     

围绝经期妇女围绝经期综合征及抑郁的危险因素

围绝经期指妇女绝经前后由于性激素减少所致的自主神经功能紊乱、生殖系统萎缩等一系列精神及躯体症状〔1〕。围绝经期是每位妇女都必经的阶段〔2〕,围绝经期女性比较敏感,在或轻或重的围绝经期综合征基础上,如果生活中出现某些重大事件,会加重心理负担,使更年期症状明显加重,同时也出现抑     

月经期哮喘2例报道

月经期哮喘是一种较少见的哮喘类型,其发生机理尚不明确,可能与患者体内性激素水平异常有关,本刊收到两篇有关病例报告,摘录如下:例1 湖北省仙槐市一医院谢劭华报告女,22岁。农民。15岁月经初潮时出现胸闷、咳嗽、哮喘。随着经血的逐渐减少而症状消失.此后每次月经来潮前两天即出现上述症状.月经周期、血量与色均正常.现妊娠7月.早期无哮喘,入院2月前因受凉咳嗽、胸闷、气喘、不能平卧.抗感染及氨茶碱治疗无效,现加重伴发热4天,1987年4月2日入院.体检:P 102次,R 21次,Bp100/70.神清,唇绀、胸廓呈轻度桶状,叩诊     

月经性肺科急症

月经性肺科急症是女性特殊生理情况下发生的一组临床病症,包括月经性咯血、月经性气酶、月经性血胸、月经性纵隔气肿和月经性哮喘等,以月经性胸痛、呼吸困难、咯血或哮喘为特征,大多认为胸部子宫内膜异位、膈肌通道及月经期前列腺素F2α(PGF2α)合成增加为主要发病机理。抑制或消除卵巢排卵为特异的治疗方法。     

围绝经期妇女哮喘临床特点分析

目的探讨围绝经期妇女哮喘临床特点。方法住院35～55岁女性哮喘患者68例,按照雌激素水平分为围绝经期哮喘组35例和对照哮喘组33例,收集两组患者症状、肺功能、生化指标、常规治疗效果等资料并对比分析。结果围绝经期哮喘患者呼吸困难评分多于对照组(P<0.05);围绝经期哮喘组出现焦虑情绪比例较高(P<0.05);围绝经期哮喘组出现呼吸困难较对照组严重(P<0.05);治疗前围绝经期哮喘患者C反应蛋白及纤维蛋白原增高、血脂异常、体重指数增加较对照组明显(P<0.05),与对照组比较,围绝经期哮喘患者常规治疗效果较差P<0.05。结论围绝经期妇女哮喘症状较重,炎症反应明显,同时存在焦虑情绪,在常规治疗的同时需注意心理疏导和抗焦虑治疗。     

妇女血脂水平的与性激素变化的关系

目的 探讨妇女血脂水平与性激素变化的关系,了解性激素在冠心病发病机制中的作用。方法 绝经前、围绝经期、绝经后妇女共６０８例,分别测定雌二醇（Ｅ２）、孕酮（Ｐ）、促卵泡生成素（ＦＳＨ）,黄体生成素（ＬＨ）、血清胆固醇（ＴＣ）、甘油三酯（ＴＧ）、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）及低旨蛋白胆固醇（ＬＤＬ－Ｃ）水平。结果 绝经后妇女Ｅ２水平较绝经前期及围绝经期妇女明显下降,后两者无明显差异,绝经后与围绝经     

妊娠期支气管哮喘治疗进展

临床研究已证明妊娠期重度及控制不佳的支气管哮喘(简称哮喘)与母亲及胎儿严重并发症相关.对于妊娠期哮喘患者,接受药物治疗比存在哮喘症状和哮喘发作更安全.所有程度的持续妊娠哮喘患者都应当应用吸入糖皮质激素作为控制药物,首选布地奈德.白三烯受体拮抗剂可以缓解支气管痉挛、减轻症状、改善肺功能.长效β2受体激动剂对于正在应用吸入糖皮质激素的患者可作为首选的添加药物.吸入短效β2受体激动剂可以作为缓解药物.对于正在接受维持量或接近维持量治疗,无不良反应、临床疗效好的妊娠哮喘患者可以继续进行变应原免疫治疗.     

Influence of the menstrual cycle on airway function in asthmatic and normal subjects

Investigations of premenstrual asthma (PMA) have been based on studies of asthmatics already aware of a deterioration of asthma premenstrually. Little is known, therefore, about relationships between the menstrual cycle and airway function in asthmatics who do not complain of PMA or in normal subjects. We investigated airway function in both of these groups for three or four consecutive menstrual cycles. Daily records of asthma symptoms and peak expiratory flow rates were maintained by 11 asthmatics and 29 normal control subjects. Standard spirometry and serum estradiol and progesterone levels were measured during the follicular, midluteal, and late luteal phases of the menstrual cycle. Airway reactivity to methacholine was tested during the follicular and luteal phases. The normal group showed no significant changes in symptoms, peak flow rates, spirometric parameters, or airway reactivity. Although the asthmatic group also demonstrated no significant changes in spirometry and airway reactivity, asthma symptoms (shortness-of-breath, cough, wheeze, and chest tightness) deteriorated significantly (p less than 0.001) from the follicular to the luteal phase, as did the morning peak flows of the asthmatics (p = 0.045). Airway function and reactivity were not related to hormone levels in either group. This study indicates that asthmatics not previously aware of PMA will record a premenstrual worsening of asthma symptoms and peak expiratory flow rates. These changes are not related to a deterioration in spirometry and airway reactivity or to the absolute levels of circulating progesterone and estradiol.     

Premenstrual Asthma: Prevalence,Cycle-to-Cycle Variability and Relationship to Oral Contraceptive Use and Menstrual Symptoms

The prevalence of asthma is higher in women than men of reproductive age and almost half of all hospitalisations for asthma in women occur during the perimenstrual phase of the cycle. The mechanisms of premenstrual asthma (PMA) are unknown and a definition of PMA has not been clearly presented in the literature. The objective of this study was to determine the prevalence of PMA using a variety of definitions, to investigate the cycle-to-cycle variation in PMA, the effects of oral contraceptive use and the relationship between PMA and premenstrual symptoms. Premenopausal women with asthma (n = 28) were prospectively followed for at least 12 weeks over 2–4 consecutive menstrual cycles. Asthma symptoms, β₂-agonist and inhaled corticosteroid use and morning and evening peak expiratory flow were recorded daily. The following types of PMA definitions were investigated: self-reported PMA, increased symptoms, increased medication use, decreased peak flow or a combination of changes in symptoms, medication and peak flow. Changes of more than 20%, for at least 2 consecutive days of the luteal phase (last 14 days of the cycle prior to menstruation) compared to the early follicular phase average (first 7 days after menstruation) were considered PMA. Using a composite definition where subjects experienced increased symptoms and medication use with or without a change in peak flow, 16 subjects were classified as having PMA (57%), while 12 did not have PMA. Only 4 subjects (25%) had PMA in every cycle examined. Fifty-five percent of subjects who used oral contraceptives had PMA, while 59% of subjects who did not use oral contraceptives had PMA. Women who were defined PMA using the composite definition were more likely than those without PMA to experience a 20% decrease in peak flow during the luteal phase. There was no relationship between asthma symptoms and premenstrual symptoms on day 1 of the menstrual cycle in women with PMA. PMA resulting in increased symptoms and medication use occurred in 57% of subjects studied for 2–4 menstrual cycles. The use of oral contraceptives is not protective and further work is required to elucidate the mechanisms of PMA.     

Questions relating to premenstrual asthma

The study of asthma in fertile women needs to consider its potentially recurrent exacerbation in a specific phase of the menstrual cycle. Premenstrual asthma (PMA) refers to the deterioration of asthma in some women of fertile age during the premenstrual phase. Prevalence varies considerably according to studies (11%-47.44%) mainly because there is no standardized definition of the illness. There is a possible link between PMA and premenstrual syndrome, which is a set of physical and psychic manifestations that occur in some fertile women during the same premenstrual phase. This relation has been widely studied but there are still several unknowns. PMA etiopathogeny is not known. It involves possible causes such as hormonal variations in the premenstrual phase, the coexistence of atopy, variations during the cycle in substances related to inflammation, like LTC4 leukotrienes, catecholamines, E2 and F2α prostaglandins and certain cytokines. Also considered are psychological factors related to this phase of the menstrual cycle, a high susceptibility to infection or increased bronchial hyperreactivity prior to menstruation. Yet no factor fully explains its etiology, consequently no specific treatment exists. Researchers have investigated hormones, anti-leukotrienes, prostaglandin synthesis inhibitors, diuretics, phytoestrogens and alternative therapies, but none has been shown to be effective.     

Menstrual-Linked Asthma

This study was conducted to determine the occurrence of menstrual-linked asthma (MLA) in India in 100 consecutive female asthmatics in the reproductive age group. The patients were required to respond to a questionnaire concerning the relationship between their asthma and the menstrual cycle. Twenty-three patients had subjective perception of deterioration in symptoms of asthma in relation to the menstrual cycle. Ten patients from both groups were also required to maintain a daily peak expiratory flow rate (PEFR) diary for 2 consecutive menstrual cycles. The mean total duration of illness in patients with MLA was significantly longer than in patients without cyclic exacerbation. Cough and breathlessness were also significantly more severe as was the disease. This was evidenced by the more frequent emergency room visits and hospitalizations in these patients. Menstrual-linked worsening of asthma was most common in the premenstrual week (17 patients). In 8 of these 17 patients, this phenomenon continued to occur during the menstrual week also. Interestingly, 1 patient complained of deterioration of asthma 2 days after menstruation was over. Such an observation is yet to be recorded. Fourteen patients reported an increase in symptoms with almost every cycle while 3 had worsening related to specific season only. Sixteen patients often required extra medication during the premenstrual and/or menstrual weeks. A significant association was also observed between severity of premenstrual syndrome and MLA. The mean PEFR values over 2 cycles revealed a significant fall in the morning as well as evening values in the premenstrual and menstrual weeks as compared to the midcycle week in patients with MLA. This fall was maximal in the premenstrual week. Such a fall was not observed in asthmatics without menstrual exacerbation of symptoms. MLA was detected in about a fourth of the female asthmatics in India and it appears to represent a more severe form of the disease. This study also documented that MLA was associated with an increase in airway resistance and was not simply due to an increased perception of symptoms during the premenstrual or menstrual weeks.     

Leukotriene Receptor Antagonists: A Good Choice in the Treatment of Premenstrual Asthma?

The aim of this study was to investigate the effects of leukotriene receptor antagonists (LTRAs) on the premenstrual exacerbation of asthma (PMA). Twenty-four female patients with mild asthma were enrolled in the study. Patients were followed for three menstrual cycles and separated into two groups based on whether they exibit premenstrual worsening of asthma symptoms (n = 11) or not (n = 13). During the first month all were treated with only inhaled steroids (IS) (run-in period); during the second month they received IS plus placebo; and during the third month they were given IS plus montelukast. Furthermore, they were advised to use beta ₂ -agonists as needed. Peak expiratory flow rate (PEFR) and symptom scores were recorded during the 3 months. Pulmonary function tests (PFT) and the levels of oestrogen, progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) were measured a week before the begining of the menstrual period. At the end of the 3-month period, it was observed that following therapy with montelukast, the patients with PMA showed significant improvement in PEFR variability and symptom scores when compared with the placebo group. Baseline FSH levels were higher, but FSH and other hormone levels and PFTs did not change in these groups. However, in the group without PMA there was no difference between the montelukast or placebo groups in PEFR variability, symptom scores, PFTs, and hormone levels. Based on the data in hand, it could be stated that LTRAs have ensured the control of symptoms and improved PEFR variability in patients with PMA by supressing inflammation. We are of the view that LTRAs would be a right choice in the treatment of patients with PMA.     

Spontaneous anovulation causing disappearance of cyclical symptoms in women with the premenstrual syndrome

In the premenstrual syndrome the negative symptoms appear during the luteal phase of the menstrual cycle. Ovulation and the formation of a corpus luteum seem to be of great importance in precipitating the syndrome. In a large group of women with premenstrual syndrome investigated daily with symptom ratings and weekly plasma estradiol and progesterone assays, 8 were found to have one ovulatory and one spontaneously occurring anovulatory menstrual cycle. In both these cycles, the post- and premenstrual phases were compared by testing for recurrence of symptoms. All patients showed a highly significant cyclical worsening of negative premenstrual symptoms during the ovulatory cycles, whereas in the anovulatory cycles the cyclical symptoms disappeared, resulting in relief of the premenstrual syndrome. These results support earlier hypotheses, suggesting that the premenstrual syndrome appears as a result of provoking factors produced by the corpus luteum. This view is in line with earlier therapeutic findings showing that induced anovulation can relieve the premenstrual syndrome.     

Serum 13-14-diOH-15-keto-prostaglandin F2 alpha and airway response to meclofenamate and metaproterenol in relation to the menstrual cycle

In order to evaluate whether adverse reactions to a nonsteroidal antiinflammatory agent (NSAIA) were related to variations in prostaglandin levels during the menstrual cycle, we measured 13-14-diOH-15-keto-prostaglandin F2 alpha in serum and the effect on airways of a single dose of 100 mg oral meclofenamate and 1.5 mg inhaled metaproterenol during the early (follicular phase) and late (luteal phase) menstrual cycle. Among 24 women with premenstrual asthma (PMA), four women with regular asthma (REA), and four healthy women, the 13-14-diOH-15-keto-PGF2 alpha averaged 140.9 +/- 68.4 pg/0.1 ml during the follicular phase but only 14.4 +/- 2.2 pg/0.1 ml during the luteal phase (p less than 0.0001). Acute asthma reactions to the meclofenamate occurred during the follicular phase in six women with PMA but were never observed during the luteal phase (p = 0.016). These reactions occurred preferentially in patients on corticosteroids (p = 0.004). Conversely, one patient with PMA had 18% improvement in FEV1 with meclofenamate during the luteal phase. A placebo-controlled, double-blind evaluation of the healthy women and the women with REA revealed a trend toward improvement in FEV1 during the luteal phase (0.15 less than p less than 0.10) but no change during the follicular phase. The effect of metaproterenol did not vary with the menstrual cycle, and there was no interaction between the effects of meclofenamate and those of metaproterenol. It appears that meclofenamate causes adverse effects on pulmonary function in asthmatic women primarily during the follicular phase of the menstrual cycle. This effect is associated with corticosteroid treatment and may be related to monthly variation in serum 13-14-diOH-15-keto-PGF2 alpha.     

Serum 13–14-diOH-15-keto-Prostaglandin F2alpha and Airway Response to Meclofenamate and Metaproterenol in Relation to the Menstrual Cycle

In order to evaluate whether adverse reactions to a nonsteroidal antiinflammatory agent (NSAIA) were related to variations in prostaglandin levels during the menstrual cycle, we measured 13–14-diOH-15-keto-prostaglandin F2alpha in serum and the effect on airways of a single dose of 100 mg oral meclofenamate and 1.5 mg inhaled metaproterenol during the early (follicular phase) and late (luteal phase) menstrual cycle. Among 24 women with premenstrual asthma (PMA), four women with regular asthma (REA), and four healthy women, the 13–14-diOH-15-keto-PGF2alpha averaged 140.9 ± 68.4 pg/0.1 ml during the follicular phase but only 14.4 ± 2.2 pg/0.1 ml during the luteal phase (p < 0.0001). Acute asthma reactions to the meclofenamate occurred during the follicular phase in six women with PMA but were never observed during the luteal phase (p = 0.016). These reactions occurred preferentially in patients on corticosteroids (p = 0.004). Conversely, one patient with PMA had 18% improvement in FEV₁ with meclofenamate during the luteal phase. A placebo-controlled, double-blind evaluation of the healthy women and the women with REA revealed a trend toward improvement in FEV₁ during the luteal phase (0.15 < p < 0.10) but no change during the follicular phase. The effect of metaproterenol did not vary with the menstrual cycle, and there was no interaction between the effects of meclofenamate and those of metaproterenol. It appears that meclofenamate causes adverse effects on pulmonary function in asthmatic women primarily during the follicular phase of the menstrual cycle. This effect is associated with corticosteroid treatment and may be related to monthly variation in serum 13–14-diOH-15-keto-PGF2alpha.     

Premenstrual asthma

Gender differences have been recognized in asthma. Specifically in women, an exacerbation in symptoms occurring a few days prior to the onset of menstruation constitutes a phenotype that is not yet fully understood. This phenomenon, called "premenstrual asthma," has been reported to affect upto 40% women with asthma. This article reviews the literature on prevalence, effect of menstrual cycle on symptoms and lung function and discusses the proposed mechanisms of pathogenesis including the effects of female sex hormones on symptoms and beta2 adrenergic receptor function, and the role of airway inflammation. Finally, the various treatment options are presented.     

Cyclic premenstrual unconjugated hyperbilirubinemia. Report of two cases.

Two young women developed unconjugated hyperbilirubinemia that fluctuated with the menstrual cycle. They were otherwise healthy, and there was no evidence of hematologic or chronic liver disease. Serum unconjugated bilirubin rose concomitant with the rise of basal temperature during the premenstrual period, and it declined immediately after the end of menses. Administration of progesterone during the postmenstrual period elevated unconjugated bilirubin. A close relation of hyperbilirubinemia to female hormones was suggested. The condition may be called "constitutional unconjugated hyperbilirubinemia with a menstrual cycle.