Ensom Mary H H, Chong Gina, Beaudin Bev, Bai Tony R
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
Ann Pharmacother. 2003 Nov;37(11):1610-3. doi: 10.1345/aph.1D090.
To describe the beneficial effects of estradiol in a severely asthmatic woman with premenstrual worsening of asthma.
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 beta-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.
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.
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 E(4) biomarker concentrations. Thus, estradiol's potential role in women with severe asthma and PMA may warrant further exploration in this subgroup.
描述雌二醇对一名患有经前期哮喘加重的重度哮喘女性的有益作用。
一名50岁白人女性，有14年严重依赖类固醇哮喘病史且每月经前期哮喘加重，在连续2个月经周期的黄体后期（第23 - 28天）被随机分配接受2毫克雌二醇或安慰剂，为期6天。尽管在安慰剂周期的黄体后期泼尼松和吸入β受体激动剂的使用量更大，但患者在雌二醇周期的同一时间段内哮喘症状、肺功能和呼气峰值流速有所改善，气道炎症生物标志物的值也更低。
该受试者对雌二醇的反应与一项涉及主要为病情得到良好控制的轻度哮喘患者的随机对照试验结果相反。此病例与随机对照研究中的大多数受试者的不同观察结果表明，重度哮喘女性更可能出现经前期哮喘（PMA）并对雌二醇产生有益反应。
在月经周期的黄体后期对患有PMA的重度哮喘女性给予雌二醇，与哮喘症状改善、肺功能和呼气峰值流速提高以及血清嗜酸性粒细胞蛋白X和尿白三烯E4生物标志物浓度降低有关。因此，雌二醇在患有重度哮喘和PMA的女性中的潜在作用可能值得在该亚组中进一步探索。
