Premenstrual asthma: report of a case with hormonal studies

We report a 39-year-old female non-smoker who has history of asthma since the age of 29 and history of allergic rhinitis at age 13. No symptomatic characteristics of premenstrual tension were reported. Forced expiratory peak flow rate (PEFR) readings showed striking falls 24 hours before menses, with the peak flows dropping from a baseline of 350 L/min to 200 L/min. The patient received 10 mg prednisolone daily which was increased to 40 mg prednisolone in the menstrual week in an attempt to maintain a normal peak flow. Daily peak flow readings and every other day hormonal studies of progesterone and estrogen both demonstrated a positive correlation between the serum progesterone and the peak flow readings. The addition of intramuscular progesterone (75 mg daily) to the bronchodilators eliminated the premenstrual dips in peak flow, and daily doses of prednisolone were reduced to 5-10 mg. We suggest that a rapid fall in serum progesterone may play an important role in the pathogenesis of premenstrual asthma.