Estradiol in Premenstrual Asthma: A Double-Blind, Randomized, Placebo-Controlled, Crossover Study

• Published in: Pharmacotherapy 2003-05, Vol.23 (5), p.561-571
• Main Authors: Ensom, Mary H. H., Chong, Gina, Zhou, Danyi, Beaudin, Bev, Shalansky, Stephen, Bai, Tony R.
• Format: Article
• Language: English
• Subjects: Adult; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - blood; Anti-Inflammatory Agents - therapeutic use; Antioxidants - administration & dosage; Antioxidants - analysis; Antioxidants - therapeutic use; Asthma - drug therapy; Biological and medical sciences; Biomarkers - analysis; Creatinine - urine; Cross-Over Studies; Double-Blind Method; Endothelin-1 - blood; Eosinophil-Derived Neurotoxin; Estradiol - administration & dosage; Estradiol - blood; Estradiol - therapeutic use; Female; Humans; Leukotriene E4 - urine; Medical sciences; Menstrual Cycle; Progesterone - blood; Quality of Life; Ribonucleases - blood; Ribonucleases - urine
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1592/phco.23.5.561.32201

Study Objectives. To characterize asthma symptoms and pulmonary function throughout two menstrual cycles, with and without exogenous estradiol administration, in women with premenstrual asthma, and to determine the effect of estradiol administration on asthma symptoms, pulmonary function, quality of life, and biomarkers of airway inflammation. Design. Double‐blind, randomized, placebo‐controlled, crossover study. Setting. Respiratory clinic and clinical research center. Subjects. Twelve women with documented premenstrual asthma ( 20% premenstrual worsening of asthma symptoms and/or of peak expiratory flow [PEF] during a 1‐month screening phase). Intervention. Each woman received either estradiol 2 mg or placebo orally between cycle days 23 and 28 (i.e., premenstrually, or before the onset of menses) in the first cycle and then crossed over to the other arm in the second cycle. Throughout both cycles, the women recorded daily morning and evening PEF readings and asthma symptoms. Measurements and Main Results. Spirometry testing and measurement of serum estradiol and biomarkers of airway inflammation were performed on days 8 (follicular phase), 22 (luteal phase), and 28 (premenstrually) of both the estradiol and placebo cycles. During the two premenstrual visits, the Asthma Quality of Life Questionnaire was administered. No notable differences were observed between the estradiol and placebo cycles in daily PEF recordings or composite asthma symptoms scores. The area under the curve (AUC) for the composite asthma symptoms versus time profile was numerically, but not statistically, lower (denoting less severe symptoms) during the estradiol cycle than during the placebo cycle. Likewise, no significant difference in AUC values for morning PEF or evening PEF was found between the estradiol cycle and the placebo cycle. Despite differences (p