[Bronchial asthma in women: peculiar aspects]

Some peculiar aspects of bronchial asthma in women are pointed out and critically examined. The course of asthma is considered during the typical endocrine phases in women (i.e. pregnancy, menstrual cycle and menopause). A worsening is often reported between the 29th and 36th week of pregnancy; the clinical status during pregnancy is attributed to the interaction between the positive effect of cortisol and the antagonism of DOCA, progesterone, aldosterone on the cortisol-glucocorticoid pulmonary receptors. Also the increase of hypotalamic concentration of noradrenaline which inhibits the pituitary-adrenal axis is considered among of the causes of the worsening of symptoms; moreover the increase of progesterone enhances the gastroesophageal reflux which acts as a trigger stimulus and causes bronchospasm. The therapeutic aspects are examined. All the pharmacologic principles are considered regarding the possible harm to the pregnant woman or the fetus. The oldest and well established molecules are considered the most reliable. Bronchial asthma is then examined with regard to menstrual cycle; pre-menstrual asthma is critically reviewed. The Authors conclude that there are neither conclusive data nor a specific therapy. Finally the pathogenesis of perimenopausal asthma is discussed. A possible hyperestrogenism with possible modification of the PGF2/PGE2 rate may be the cause of this syndrome.