Take a Deep Breath, Red Hot Mamas: Menopause and Asthma

By: Red Hot Mamas

Published: May 26, 2010

Asthma is one of the most common chronic conditions in the United States. In 2005, about 20 million adults and 9 million children under the age of 18 have been diagnosed. Significantly more women than men suffer from asthma (9.1% of females vs. 5.1% of males). Asthma is a health issue for women, especially those of color. According to the National Health Interview Survey, in 2002, Puerto Ricans were almost 80% more likely to have been diagnosed with lifetime asthma than non-Hispanic whites. Non-Hispanic blacks and American Indians were about 25% more likely to be diagnosed.

Definition and Causes of Asthma

Asthma is a chronic respiratory disease that narrows and attacks the airways. Tubes that bring air to the lungs become inflamed and shorten the supply of oxygen. Asthma “attacks” are characterized by a combination of symptoms including shortness of breath, coughing, wheezing and chest pains/tightness. It is not contagious but the effects can be unpredictable, dangerous and even life-threatening. Symptoms can start at any age and can be hereditary.

Adult-onset asthma develops in people over the age of 20 years old. Many things can trigger an asthma attack:

  • The timing of a severe cold or flu. Upper respiratory illnesses (bronchitis, viral infections or even a common cold) can often set asthma off.
  • Environmental factors (allergies, pollution)
  • Smoking
  • Medications
  • Cold air
  • Exercise
  • Gastroesophageal reflux
  • Occupational factors (exposure to certain workplace materials like chemicals, latex, etc.)
  • Hormonal changes

Pregnancy, Menstruation, Menopause and Hormone Therapy/p>

About 5% women experience symptoms of asthma when they are pregnant and approximately a third of these women report a worsening of their symptoms during the pregnancy (particularly in the 2nd and 3rd trimester). Part of this is because the baby pushes up the lungs and makes it harder to the lungs to expand when you breathe deeply. Recent studies from the American Academy of Allergy, Asthma and Immunology reveal a woman’s menstrual cycle and maturation of a woman’s hormonal system may constrict airways and worsen symptoms. According to the study, about 1/3 of the women believed their asthma symptoms worsened immediately preceding menstruation.

Hormonal fluctuations can increase mucus production in the upper and lower airways making it harder for the lungs to expel air and worsen symptoms. Studies show there is an increase in near-fatal asthma cases during the first four days of the menstrual cycle. So, what happens to a woman during menopause when all hormone levels decrease?

Changes in estrogen and progesterone levels may cause constriction of the airways. The question of whether hormone therapy exacerbates asthma is uncertain and further studies are clearly needed. In a study published in the Archives of Internal Medicine, postmenopausal women taking hormone therapy were 2.29 times more likely to develop asthma than those not taking estrogen. The use of hormone therapy should be discussed with your doctor if you have a history of asthma. Sometimes a referral to an asthma specialist may be necessary.

Diagnosing Asthma

The process of diagnosing asthma is the same for people of all ages. Common symptoms of asthma include:

  • Coughing, especially at night
  • Wheezing
  • Shortness of breath
  • Tightness in your chest

Symptoms can be mild to severe and often stop and start. Symptoms are usually worse at night.

If you suspect you may have asthma, discuss your symptoms with your healthcare practitioner. At an older age, symptoms of asthma are often confused with those of a common cold or cough. Wheezing and shortness of breath can also be caused by many other conditions and lung diseases including vocal cord dysfunction and pulmonary edema, a disease caused by heart failure. Treatments are very different so a correct diagnosis is important. Be prepared for your doctor to ask the following questions:

During the past 12 months, have you:

  • Had a sudden, severe episode or recurrent episodes of wheezing, coughing or shortness of breath?
  • Had colds that “go to the chest” taken more than 10 days to get over?
  • Had wheezing, coughing or shortness of breath only when you’re in certain places, such as your home workplace or outdoors?
  • Had wheezing, coughing, shortness of breath when exposed to certain substances such as pollen, tobacco smoke, cat dander or perfume?
  • Used any medications that help you breathe better? If so, how often did you use them and how well did they work?

In the past four weeks, have you had wheezing, coughing or shortness of breath..

  • At night that has awakened you?
  • In the early morning?
  • After running, moderate exercise or other physical activities?

Be prepared to talk about your family health history as asthma is a hereditary disease. After analyzing your symptoms and history of symptoms, your healthcare provider will probably follow-up with a physical examination.

Physical examinations usually include a variety of ways to find out if allergies are triggering your symptoms. By listening to your lungs with a stethoscope, healthcare providers can hear wheezing or other signs of obstructed airways. Your healthcare provider will also looks up your nose for nasal secretions, swelling or polyps which are other signs of allergies. Your skin may be examined for other conditions that are associated with asthma such as eczema or hives.

An important step in diagnosing asthma includes pulmonary (lung) functioning tests. There are three tests that can directly measure your breathing:

  1. Spirometry- This test determines how well you breathe by measuring how much air your lungs hold. It takes 10 to 15 minutes and requires you to take deep breaths and forcefully exhale into a hose connected to a machine called a spirometer.
  2. Challenge Test- With this assessment, you are required to deliberately inhale an airway-constricting chemical or take a few breaths of very cold air. After inhaling this substance, you retake the spirometry test.
  3. Peak Expiratory Flow- Like the spirometry test, this test measures how well you breathe. You are required to forcefully blow into a peak flow meter (a small, hand held device that measures the rate at which you can force air out of your lungs).
  4. If you are diagnosed with asthma, you will probably need to monitor your peak flow over a six to eight week period as you take asthma medications. The good news is asthma is a treatable condition.

Manage Your Asthma by Controlling Symptoms

You can control your symptoms of asthma by reducing or eliminating allergens from your environment. Avoid indoor and outdoor allergens and irritants. There are many ways to go about this including the following:

  • Give your lungs a break, STOP SMOKING. Your lungs are working over time and are trying to send you a message.
  • Reduce pet allergens by dusting and cleaning often
  • Lower mold allergens by making sure bathrooms, kitchens and basements have good air circulation and are cleaned often.
  • Reduce dust mites by washing all bedding every week in hot water, removing carpeting, cleaning fabrics and curtains often and cutting down the humidity.
  • Cover mattresses with a mattress pad
  • Use air filters and air conditioners
  • Vacuum often

Also, a variety of prescription medications are available. Asthma sufferers can enjoy healthy, active lives by controlling their symptoms. Medicines can help keep the air tubes in your lungs open. Two forms of asthma medications are available including bronchodilators and anti-inflammatories.
Asthma attacks can be controlled and prevented by taking bronchodilators. Anti-inflammatories help keep your air tubes open to prevent attacks. Many forms are available including sprays, pills, powders, liquids and shots. Discuss all treatment options with your healthcare provider so you can be in control of your asthma. Also, drink lots of water.

References:

“Asthma and Older People”, American Lung Association, July 2005.

“Asthma in Adults”, University of Maryland Medical Center, March 2002.

“Asthma: Steps in Diagnosis”, Mayo Clinic Tools for Healthier Lives, March 8 2006.

Frieri, M., 2004, Management of Asthma in Women: Women’s Health in Primary Care, Vol. 7, No. 8, September 2004, pp. 408-413.

Gianakos, D. G., 2004, The Wheezing Patient: Avoiding Missteps in Diagnosis and Management: Women’s Health Gynecology Edition, Vol. 4, No. 5, September-October 2004, pp. 239-244.

“Hormone Replacement Therapy: A Risk Factor For Asthma?”, Pulmonary Reviews.com, Vol. 5, No. 12, December 2000.

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