MENSTRUATION RELATED ASTHMA
Premenstrual worsening of asthma has been reported in as many as 30% to 40% of women in some studies, whereas worsening of pulmonary functions has been reported even in women not aware of worsening symptoms.The pathophysiology is uncertain because estrogen replacement in postmenopausal women has been shown to worsen asthma, whereas estradiol and progesterone administration have been variably reported to improve or have no effect on asthma in women with premenstrual asthma.Studies would indicate that, in general, bronchial responsiveness and symptoms improve in asthmatics during pregnancy.The clinical significance of menstruationrelated asthma is still unclear because some studies have reported that up to 50% of emergency department visits by women were premenstrual, whereas others have reported no association with menstrual
FOODS, DRUGS, AND ADDITIVES
Documentation in the literature of food allergens as triggers for asthma is not available. However, additives, specifically sulfites used as preservatives, can trigger life-threatening asthma exacerbations. Beer, wine, dried fruit, and open salad bars in particular have high concentrations of metabisulfites. Severe oral corticosteroid-dependent patients should be warned about ingesting foods processed with sulfites. Another additive producing bronchospasm is benzalkonium chloride, which is found as a preservative in some nebulizer solutions of antiasthmatic drugs. Aspirin and other nonsteroidal anti-inflammatory drugs can precipitate an attack in up to20%of adults with asthma. The mechanism
is related to cyclooxygenase inhibition, and 5-lipoxygenase inhibition can prevent the symptoms. The prevalence increases with age. The greatest frequency occurs in severe corticosteroid-dependent asthmatics in their fourth and fifth decades who also have perennial rhinitis and nasal polyposis (presence of several polyps). Other drugs that do not precipitate bronchospasm but which prevent its reversal are the β-blocking agents
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