title: Characteristics of perimenstrual asthma and its relation to asthma severity and control: data from the Severe Asthma Research Program.
abstract: BACKGROUND
  Although perimenstrual asthma (PMA) has been associated with severe and difficult-to-control asthma, it remains poorly characterized and understood. The objectives of this study were to identify clinical, demographic, and inflammatory factors associated with PMA and to assess the association of PMA with asthma severity and control.
  
  
  METHODS
  Women with asthma recruited to the National Heart, Lung, and Blood Institute Severe Asthma Research Program who reported PMA symptoms on a screening questionnaire were analyzed in relation to basic demographics, clinical questionnaire data, immunoinflammatory markers, and physiologic parameters. Univariate comparisons between PMA and non-PMA groups were performed. A severity-adjusted model predicting PMA was created. Additional models addressed the role of PMA in asthma control.
  
  
  RESULTS
  Self-identified PMA was reported in 17% of the subjects (n = 92) and associated with higher BMI, lower FVC % predicted, and higher gastroesophageal reflux disease rates. Fifty-two percent of the PMA group met criteria for severe asthma compared with 30% of the non-PMA group. In multivariable analyses controlling for severity, aspirin sensitivity and lower FVC % predicted were associated with the presence of PMA. Furthermore, after controlling for severity and confounders, PMA remained associated with more asthma symptoms and urgent health-care utilization.
  
  
  CONCLUSIONS
  PMA is common in women with severe asthma and associated with poorly controlled disease. Aspirin sensitivity and lower FVC % predicted are associated with PMA after adjusting for multiple factors, suggesting that alterations in prostaglandins may contribute to this phenotype.
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, The University of Pittsburgh Asthma Institute @UPMC and the University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors: Chitra K
authors: CK
authors: Rao
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, The University of Pittsburgh Asthma Institute @UPMC and the University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors: Charity G
authors: CG
authors: Moore
authors: Division of Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC.
authors: Eugene
authors: E
authors: Bleecker
authors: Division of Allergy and Clinical Immunology, Department of Medicine, University of Wisconsin-Madison, Madison, WI.
authors: William W
authors: WW
authors: Busse
authors: Division of Allergy, Pulmonary, Immunology, Critical Care, and Sleep, Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX.
authors: William
authors: W
authors: Calhoun
authors: Division of Pulmonary & Critical Care Medicine, Department of Medicine, Washington University in St Louis, St Louis, MO.
authors: Mario
authors: M
authors: Castro
authors: Division of Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Imperial College London, London, England.
authors: Kian Fan
authors: KF
authors: Chung
authors: Department of Pathobiology, Cleveland Clinic, Cleveland, OH.
authors: Serpil C
authors: SC
authors: Erzurum
authors: Division of Pulmonary and Critical Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors: Elliot
authors: E
authors: Israel
authors: Division of Biostatistics, Department of Preventive Medicine and Biometrics and Department of Physiology and Biophysics, University of Colorado Denver and National Jewish Health, Denver, CO.
authors: Douglas
authors: D
authors: Curran-Everett
authors: Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, The University of Pittsburgh Asthma Institute @UPMC and the University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: wenzelse@upmc.edu.
authors: Sally E
authors: SE
authors: Wenzel
mesh_terms: D000293:Adolescent; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001241:Aspirin / Q000009:adverse effects; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008598:Menstruation / Q000502:physiology*; D008875:Middle Aged; D008954:Models, Biological; D010641:Phenotype; D011453:Prostaglandins / Q000502:physiology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014797:Vital Capacity / Q000502:physiology; D055815:Young Adult
chemical_list: D018927:Anti-Asthmatic Agents; D011453:Prostaglandins; D001241:Aspirin
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