Hormonal cycles may alter course of asthma for women

Experts are calling on physicians to be alert to gender differences. Also, new guidelines call for greater emphasis on objective measures of disease severity.

By Victoria Stagg Elliott, AMNews staff. Nov. 14, 2005.

Physicians should be attuned to the possibility that women with asthma may experience a worsening or improving of symptoms in response to hormonal changes such as those that are part of the regular monthly cycle, menopause or pregnancy. And this may require changes in medication dosage, according to an expert panel at this month's American College of Allergy, Asthma & Immunology meeting in Anaheim, Calif.

"Twenty percent to 40% of women will have a premenstrual worsening of asthma, and this may require some modification of their therapy around that time. It's not broadly recognized but it's in the literature," said Nancy K. Ostrom, MD, chair of the symposium and co-director of the Allergy & Asthma Medical Group and Research Center in San Diego. "They may not be entirely comfortable bringing it up, but we need to ask about that and listen to them."

The symposium was convened in recognition of the growing amount of data that women are more likely to develop asthma as adults and are more likely to be hospitalized or need to visit the emergency department because of this disease.

"Common wisdom is that asthma presents in childhood, but I see a number of women who first present between 30 and 50 years of age," said Dr. Ostrom.

"We're becoming aware that there are decided differences in presentation, hospitalization and even death rates in women versus men," she said.

Experts are particularly focused on issues regarding asthma care during pregnancy. Specifically, some women may fear congenital anomalies and discontinue therapy without consulting their physicians.