Objective: To determine if supplemental estrogen should be used as steroid-sparing agents in asthmatic women Design: Case series.

Objective: To determine if supplemental estrogen should be used as steroid-sparing agents in asthmatic women

Design: Case series.

Setting: Ambulatory care, community hospital.

Patients: proffer sample of three steroid-dependent asthmatic women

Intervention: Addition of conjugated estrogen to existing asthma treatment.

Main issue measure: Ability to decrease oral steroid requirement.

Results: The mean age of the women was 55 [+ or -] 11 years; sum of two units were former smokers (cases 1 and 2) and the same was a nonsmoker (case 3) united woman (case 3) was premenopausal and noted worsening of her asthma before and during mense The other sum of two units women (cases 1 and 2) were postmenopausal. All three had been symptomatic from their asthma for 132 [+ or -] 76 years. Each woman was being treated with maximal doses of inhaled albuterol, inhaled steroids, and therapeutic theophylline doses. Despite this aggressive management, all three women required daily supplemental steroids (mean dose, 267 [+ or -] 115 mg of prednisone). Case 3 was started in succession a regimen of norethindrone/ethinyl estradiol 1/35 and cases 2 and 3 were begun in succession regimens of daily conjugated estrogen 0625 mg from one side of to the other the next 12 to 24 weeks, the conditions of all three women were symptomatically improved and their steroid therapy was discontinued. In addition, steroid-associated side issues of hypertension, weight gain, osteoporosis, and easy bruising lessened

Conclusion: Although this recent observation of the steroid-sparing validity of estrogens remains preliminary, further thought may help advance understanding of the mechanisms and treatment of asthma in women

(Chest 1994; 106:318-19)

Asthma exacerbations may be derived from numerous irritant and biologic triggers. Although not well studied, menstruation is notion to be a significant factor in many asthmatic women Several scans have reported that one third of asthmatic women note worsening of their airways disease around menses(1)(2)(3) Additionally, a certain authors have suggested that death in asthmatic women may be related to menstrual factors.(4) Furthermore, clinical improvement in respiratory symptoms has been noted in one asthmatic women started on oral contraceptive therapy.(5) The use of supplemental estrogensas steroid-sparing agents for women with methodical asthma, however, has not been investigated (to our knowledge). We describe three women with refractory asthma in whom the addition of supplemental estrogen l to improvement in symptoms and the elimination of oral steroid use.

CASE REPORTS

CASE 1

The first patient, is a 55-year-old white woman, former smoker with a known history of steroid-dependent asthma for the past 10 years. Her asthma had been difficult to hinder despite the use of high doses of inhaled beclomethasone, cromolyn and metaproterenol, oral metaproterenol and theophylline, and 15 to 20 mg of daily prednisone. The patient had undergone a hysterectomy sparing the ovaries 10 years earlier.

Prior to initiating estrogen therapy, the patient was overweight and cushingoid in appearance. Her BP was 150/90 mm Hg Findings from the remainder of her examination were remarkable for postnasal drainage, diffuse wheezing, +1 peripheral edema, and numerous ecchymose forward her upper extremities.

Pulmonary function testing revealed evidence of rigid obstruction with an [FEV.sub.1] of 1 L with statistically significant reversibility with 5 mg of an isoetharine aerosol. Her chest radiograph showed hyperinflation. be deriveds of routine laboratory work were within normal limits with no evidence of eosinophilia. Follicle-stimulating hormone and luteinizing hormone were drawn and horizontals were elevated, consistent with a postmenopausal state.

Daily oral conjugated estrogen therapy, 0625 mg was initiated in March 1991 through the next 12 weeks, the patient's asthma improved markedly. Her prednisone dose was slowly tapered by dint of 2.5 mg every 2 to 3 weeks until she was not taking any prednisone for the first time in 8 years. In addition, her theophylline therapy was discontinued. She continued to use her inhalers nevertheless at lesser dosages. Further, her [FEVsub1] improved to 137 L with an FVC of 261 L Repeated follicle-stimulating hormone and luteinizing hormone flats were consistent with adequate replacement of estrogen therapy.

For the past year, the patient has remained well, without prednisone, with fewer exacerbations of her disease. In addition, she has missing weight, normalized her BP, and is no longer troubl on easy bruising.

CASE 2

The inferior patient is a 66-year-old white woman with a known diagnosis of asthmatic bronchitis for the past 5 years. Her respiratory symptoms of cough and insensibility production were not well controll despite therapeutic oral theophylline as well as four pants of both inhaled albuterol and beclomethasone four times daily. Approximately 2 years ago, the patient experienced more attend much [i]or[/i] regularly exacerbations of her underlying lung disease, requiring at first, intermittent prednisone and then continuous prednisone at 20 mg/d Concurrently the patient was bothered by way of recurrent sinusitis, treated with nasal steroids, antibiotics, and finally surgical decompression.

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