Persistent airway inflammation and high exacerbation rate in asthma that starts at menopause.
OBJECTIVE
Asthma that begins around the time of menopause is frequently characterised by marked clinical severity and poor response to treatment. We sought to assess the clinical characteristics, bronchial responsiveness, perception of induced bronchoconstriction and airway inflammation in women with menopausal asthma, as compared to women of a similar age with pre-existing asthma.


METHODS
Nine women with pre-existing asthma were selected for clinical severity (symptoms, lung function and medication requirements) similar to that in 11 women with menopausal asthma. Anti-asthmatic treatment in all of the study patients included high dose inhaled (with or without oral) corticosteroids.


RESULTS
The women with menopausal asthma demonstrated less atopy, more chronic recurrent sinusitis, similar airway responsiveness, and similar perception of induced bronchoconstriction, but a significantly higher sputum eosinophil count (19.5 +/- 10.8 versus 3.3 +/- 4.3%; p < 0.001) and a higher severe exacerbation rate during the 1-year follow-up period (5.09 +/- 4.85 versus 0.78 +/- 0.97; p < 0.05). Sputum eosinophil count and severe asthma exacerbation rate correlated well in both groups considered as a whole (r = 0.65; p < 0.005).


CONCLUSIONS
The eosinophilic airway inflammation present in women with menopausal asthma is poorly responsive to anti-inflammatory treatment with corticosteroids and predisposes to frequent severe exacerbations. Airway inflammation should be monitored in women with menopausal asthma.
Balzano
G
G
Division of Pneumology, Scientific Institute of Telese Terme (BN), "Salvatore Maugeri" Foundation, 82037 Telese, Terme BN, Italy. gbalzano@fsm.it
Fuschillo
S
S
De Angelis
E
E
Gaudiosi
C
C
Mancini
A
A
Caputi
M
M
D000328:Adult; D017668:Age of Onset; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006304:Health Status; D006801:Humans; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged; D012129:Respiratory Function Tests; D012720:Severity of Illness Index
D018927:Anti-Asthmatic Agents