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Estradiol in Severe Asthma with Premenstrual Worsening

Professor, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Clinical Pharmacy Specialist, Pharmacy Department, Children's & Women's Health Centre of British Columbia, Vancouver

Gina Chong

BSc(Pharm) Student, Faculty of Pharmaceutical Sciences, University of British Columbia

Bev Beaudin, RRT

Clinical Specialist, Asthma Education Centre, St. Paul's Hospital, Vancouver

Tony R Bai, MD MRCP(UK) FACP FRACP FRCP(C)

Professor of Medicine, University of British Columbia and Department of Respiratory Medicine, St. Paul's Hospital

Reprints: Mary HH Ensom PharmD FASHP FCCP FCSHP, Department of Pharmacy (0B7), Children's and Women's Health Centre of British Columbia, 4500 Oak St., Vancouver, British Columbia V6H 3N1, Canada

OBJECTIVE: To describe the beneficial effects of estradiol in a severely asthmatic woman with premenstrual worsening of asthma.

CASE SUMMARY: A 50-year-old white woman, with a 14-year history of severe steroid-dependent asthma and monthly premenstrual worsening of asthma, was randomized to receive estradiol 2 mg or placebo for 6 days during the late luteal phase (days 23–28) of 2 successive menstrual cycles. Despite greater prednisone and inhaled ß-agonist use during the late luteal phase of the placebo cycle, the patient exhibited improved asthma symptoms, pulmonary function, and peak expiratory flows, as well as lower values for biomarkers of airway inflammation during the same time period of the estradiol cycle.

DISCUSSION: This subject's response to estradiol was in contrast to results of a randomized, controlled trial involving patients with predominantly mild asthma under excellent control. The discrepant observations for this case versus the majority of subjects in the randomized, controlled study suggest that premenstrual asthma (PMA) and a beneficial response to estradiol may be more likely in women with severe asthma.

CONCLUSIONS: The administration of estradiol during the late luteal phase of the menstrual cycle to a woman with severe asthma with PMA was associated with improved asthma symptoms, pulmonary function, and peak expiratory flows, and lower serum eosinophil protein X and urinary leukotriene E₄ biomarker concentrations. Thus, estradiol's potential role in women with severe asthma and PMA may warrant further exploration in this subgroup.

Key Words: estradiol, estrogen, premenstrual asthma

Published Online, October 1, 2003. www.theannals.com, DOI 10.1345/aph.1D090

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