menstrual asthma
Introduction
Introduction to menstrual asthma Menstrual asthma refers to asthmatic women and their menstrual cycle, the phenomenon of asthma exacerbations in the premenstrual or menstrual period, usually in women of childbearing age 5 to 7 days before menstruation, there is a clear tendency to asthma, especially before menstruation 2 ~ The 3-day incidence peaked, called pre-menstrual asthma, and the symptoms gradually decreased after menstruation. Some episodes occur during menstruation and are called "menstrual asthma." Studies have shown that about 30% to 40% of asthmatic women have worsened or worsened asthma symptoms before or during menstruation. The severity of symptoms varies from person to person. Lighter cases have only chest tightness, and severe cases require hospitalization. basic knowledge Sickness ratio: 0.05% Susceptible people: women Mode of infection: non-infectious Complications: Asthma
Cause
Causes of menstrual asthma
(1) Causes of the disease
The special type of asthma with menstruation as a triggering factor, the current research speculates that:
1 endogenous prostaglandin secretion increased (increased PGF2a);
2 The level of progesterone and estrogen decreased in vivo;
3 dysmenorrhea
Changes in the immune status of the menstrual period before April.
(two) pathogenesis
The pathogenesis of this disease is not completely clear, and may be related to changes in hormone levels in the body during the menstrual cycle. Some authors believe that it may be related to the following factors:
1. Menstrual asthma is associated with increased excitability of the patient's vagus nerve.
2. Low levels of progesterone during menstruation lead to contraction of bronchial smooth muscle, progesterone causes microvascular leakage and the like.
3. Prostaglandin F2 was significantly increased, bronchial smooth muscle strongly contracted, and induced asthma attacks.
4. The increase of estrogen levels in the body makes the body imbalance, and the symptoms of asthma are attacked or aggravated during the menstrual period.
Prevention
Menstrual asthma prevention
1. Enhance the body and improve the body's reactivity.
2. Eliminate tension and fear during premenstrual and menstrual periods, and maintain a comfortable mood and emotional stability.
3. Asthmatic women who are prone to menstruation before menstruation can take certain drugs orally several days before the onset of periodic asthma, such as:
(1) Ketotifen 2 times / d, 1 mg / time.
(2) The timely use of progesterone intramuscular injection before menstruation can prevent the sudden drop of progesterone level and achieve prevention and treatment; at the same time, it is effective for premenstrual tension.
(3) Alkyne hydroxyandrostazole can be used as appropriate, effective for premenstrual stressors.
Complication
Menstrual asthma complications Complications asthma
Very rare.
Symptom
Symptoms of menstrual asthma Common symptoms Bronchial smooth muscle spasm Menstrual flow less breathing difficulties Wheezing chest tightness
The main clinical feature of patients with menstrual asthma is asthma symptoms or exacerbations in the premenstrual or menstrual period. The symptoms of the respiratory tract are similar to other types of asthma.
Examine
Menstrual asthma check
Prostaglandin F2 was significantly increased.
Forced vital capacity: PEF in menstrual period decreased during menstrual period, but the decline may not be serious. PEF may decrease slightly in the morning, and severe pre-menstrual asthma patients may have a significant decrease in premenstrual PEF and no response to conventional treatment. Airway responsiveness was measured in airway responsiveness in women with well-controlled asthma before and after menstrual cramps. Results showed no significant difference in airway responsiveness and FEV1.
Diagnosis
Diagnosis and diagnosis of menstrual asthma
diagnosis
Regular asthma can be diagnosed before and after menstruation.
Differential diagnosis
Patients with menstrual asthma do not necessarily show signs of wheezing. Conversely, they have wheezing and difficulty breathing. They may not be diagnosed with asthma and need to be identified with the following diseases.
1. Cardiac asthma early left ventricular dysfunction often occurs at night with dyspnea, accompanied by expiratory wheezing symptoms similar to bronchial asthma, such patients often have significant history and signs of heart disease, mostly sitting breathing, can There are signs such as diffuse fine wet voices at the bottom of the lungs. When the difficulty is identified, the selective 2 receptor agonist can be inhaled for diagnostic treatment.
2. Spontaneous pneumothorax in the pneumothorax based on chronic obstructive pulmonary disease, pneumothorax signs are often not obvious, but manifested as sudden dyspnea, some patients with expiratory wheezing (especially contralateral pneumothorax), clinically It is easy to be confused with asthma, and it is necessary to improve vigilance. Suspected people should have early X-ray examination to confirm the diagnosis.
3. Atmospheric obstructive disease tumors, foreign bodies, inflammation and congenital anomalies can cause obstruction of the larynx, glottis, trachea or main bronchus (intracavitary or external pressure), causing difficulty in breathing and wheezing, but this The wheezing sound is often particularly noticeable in a certain part, mostly biphasic wheezing sounds mainly in the inspiratory phase, often accompanied by abnormal thickening of the bronchial sounds of the bottom of the lungs, throat examination, X-ray tracheal forefront tomography and Fibrobronchoscopy can confirm the diagnosis.
4. Exogenous allergic alveolitis can present typical asthmatic manifestations, but these patients often have history of exposure to allergens (wild grass, pigeon dung, etc.), and diffuse interstitial lesions can be seen on X-ray films. Infiltration, blood eosinophils are significantly increased, which is helpful for identification.
5. Urgent, chronic bronchitis, such patients may have wheezing and dyspnea, and asthma patients may also have no wheezing and only a paroxysmal dry cough, sometimes difficult to identify clinically, but the symptoms of bronchitis patients are not offensive The characteristics of chronic bronchitis have long-term chronic cough, bronchitis and cough are generally more, bronchodilator inhalation test or day and night PEF volatility measurement is helpful to identify.
6. Allergic bronchopulmonary aspergillosis (ABPA) is often characterized by repeated asthma, with cough, cough, phlegm and mucus purulent, sometimes accompanied by bloodshot, can be isolated from brown-yellow sputum, often There is low fever, the lungs can smell wheezing or dry snoring, X-ray examination shows infiltrative shadow, segmental atelectasis, toothpaste sign or finger sign (bronchial mucus embolism), peripheral blood eosinophils are significantly increased, The aspergillus allergen skin prick can have a biphasic skin reaction (immediate and delayed), and serum IgE levels are usually more than 2 times higher than normal.
7. Gastroesophageal reflux (GER) postnasal drip syndrome (PNDS) In esophageal achalasia, sputum sputum and other diseases, often the stomach or duodenal contents through the lower esophageal sphincter back into the esophagus, anti Most of the fluid is acidic. As long as a small amount is inhaled into the trachea, it can stimulate the upper airway receptor to reflexively cause bronchospasm through the vagus nerve, and cough and wheezing occur. It is reported that the incidence of GER in severe asthma patients can be Close to 50%, indicating that GER is at least an important cause of asthma attacks, symptoms are difficult to control, targeted treatment of GER, can significantly improve asthma symptoms.
Postnasal drip syndrome (PNDS), common in chronic sinusitis, its secretions often enter the trachea through the posterior nasal passages when the patient is lying down, can cause asthma-like cough and wheezing symptoms, and is also a recurrence of some asthma patients and An important factor in poor efficacy.
