Menstrual asthma

　　1. Causes

　　Menstrual asthma, a special type of asthma triggered by menstruation, the current research suggests that the causes may include: ① Increased endogenous prostaglandin secretion (increased PGF2a); ② Decreased levels of progesterone and estrogen in the body; ③ Dysmenorrhea; ④ Changes in the immune state before and during menstruation.

　　2. Pathogenesis

　　The pathogenesis of this disease has not been fully clarified 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:

　　10. The menstrual asthma is related to the increased excitability of the vagus nerve in patients.

　　9. The low level of progesterone during the menstrual period causes the bronchial smooth muscle to contract, and progesterone causes microvascular leakage, etc.

　　8. Prostaglandin F2α is significantly increased, causing strong contraction of the bronchial smooth muscle, triggering asthma attacks.

　　7. The increased level of estrogen in the body causes the body's balance to be disrupted, triggering asthma symptoms to occur or worsen during the menstrual period.

　　Complications and asthma-like conditions can lead to airway obstruction, causing respiratory distress, and even leading to sudden death due to concurrent lung infections.

　　Sudden death is the most serious complication of asthma, as it often has no obvious warning symptoms. Once it occurs suddenly, it is often too late to save and death can occur. The important causes of asthma sudden death can be summarized as:

　　1. Specific hypersensitivity reaction:Due to the high sensitivity of the airway, specific or non-specific stimulation, especially during airway reactivity testing, can cause severe laryngeal, tracheal edema and widespread bronchospasm, leading to tracheal obstruction and asphyxiation or triggering severe arrhythmias, even sudden cardiac arrest and death.

　　2, Lung atresia:It can be due to widespread sputum plug blocking the bronchi or the side effects of isoproterenol.

　　The main clinical characteristics of menstrual asthma patients are that the symptoms of bronchial asthma appear or worsen before or during the menstrual period, and the symptoms of the respiratory tract are similar to those of other types of asthma.

　　In fact, there is a close relationship between the menstrual cycle and the respiratory system.

　　For example, many people feel stuffy during their menstrual period, which is known as 'menstrual nasal congestion'. This is due to the increased sensitivity of the nasal mucosa to ovarian estrogen. When the menstrual period is about to start, the level of estrogen secreted by the ovary increases, causing the nasal mucosa to become congested and swollen, resulting in nasal congestion.

　　If there is epistaxis, it is what is said in folk medicine as 'reverse menstruation', which is called compensatory menstruation in medicine. Compensatory menstruation can occur in the nose, stomach, intestines, bladder, lungs, breast, skin, skin ulcers, moles, external auditory canals, eyes, eyelids, umbilical and abdominal wall fistulas, etc., among which epistaxis is most common, accounting for about one-third of compensatory menstruation. Compensatory menstruation is more common in nosebleeds due to the close relationship between nasal mucosa and female reproductive organs. Some animal experiments have been done, where estrogen was injected into monkeys, and it was found that the nasal mucosa of the monkeys showed congestion and vascular changes, indicating that the nasal mucosa is very sensitive to estrogen. Girls sensitive to estrogen will experience a cyclical bleeding phenomenon similar to endometrial bleeding under the influence of the cyclical changes of estrogen. These girls always feel uncomfortable and restless before the onset of menstruation, with a bloated and heavy lower abdomen, and are not satisfied with anything. When a nosebleed occurs, the whole body may feel more comfortable. Some girls may not have menstruation when they have compensatory menstruation, and some may have menstruation, but the amount is significantly reduced. There is no need to be panic-stricken when there is epistaxis with compensatory menstruation. You can tilt your head back, apply a cold towel to the forehead, plug the nostrils with cotton soaked in 'Sanqi powder' or Yunnan white powder or 1% ephedrine solution, press the 'Yingxiang acupoint' on both sides of the nostrils with two fingers, and at the same time, you can take vitamin K and other hemostatic drugs orally.

　　Some girls may experience voice changes during their menstrual period, mostly difficulty in starting the voice, hoarseness, decreased volume, voice modulation disorders, and vocal fatigue. This is due to the obvious congestion and edema of the vocal cords during the menstrual period. Therefore, girls should pay attention to throat hygiene during the menstrual period, pay more attention to 'vocal cord rest', do not overuse their voice, and do not speak for too long. The voice should not be too loud, and it is forbidden to force the voice. Even when speaking, it should be 'lowered by eight degrees', not 'raised by eight degrees', to avoid damaging the vocal cords. Prognosis

　　The condition of most simple menstrual asthma patients is not severe, and the prognosis is good. Only a few cases can be life-threatening, often occurring in patients with chronic asthma whose condition worsens during the menstrual period.

　　Prostaglandin F2α is significantly increased.

　　Forced vital capacity:The PEF of menstrual asthma women may decrease during the menstrual period, but the decrease may not be severe. The PEF in the morning may slightly decrease. For patients with severe menstrual asthma attacks, the PEF before menstruation may significantly decrease, and they may not respond to conventional treatment. The airway reactivity test showed that there were no significant differences in airway reactivity and FEV1 when the airway reactivity test was performed one week before and after the onset of menstruation in women with well-controlled asthma.

　　1. Walnut Kernel

　　Grind 1000 grams of walnut kernel into powder, grind 500 grams of Fructus psoraleae into powder, mix it with honey to make it like molasses, take one spoonful with wine in the morning. For those who cannot drink alcohol, take it with warm water and avoid mutton. It is suitable for symptoms such as lung deficiency, chronic cough, asthma, constipation, and post-disease weakness.

　　2. Almond Porridge

　　Take 10 grams of almond kernel, peel it, grind it into powder, decoct the water and remove the dregs, add 50 grams of glutinous rice, add appropriate amount of rock sugar, cook it into porridge, and eat it twice a day. It can ventilate the lung, resolve phlegm, stop coughing, and is a good medicine for treating cough and asthma.

　　3. Sugar Water White Kernel

　　Take 50 grams of white kernel, dry-fry it with low heat, crack the shell with a knife, remove the shell and outer casing, wash it clean with clear water, and cut it into small pieces. Wash the pot clean, add a bowl of clear water, add the white kernel, boil it on high heat, then turn to low heat to simmer for a moment, add 50 grams of sugar, boil it to a boil, add a little sugar osmanthus, and it is ready to eat.

　　I. Treatment

　　The treatment of menstrual asthma is determined according to the severity of the disease, and the treatment principles are similar to those of conventional asthma treatment.

　　1. For patients with mild attacks, inhaled β2-agonists and inhaled corticosteroids can be administered, and theophylline can be taken orally.

　　2. For patients with more severe attacks, oxygen therapy and magnesium sulfate can be added, and aminophylline can be administered intravenously under blood drug concentration monitoring, and intravenous corticosteroids can be administered.

　　3. For critically ill patients, artificial ventilation should be provided in addition to medication. For women with premenstrual asthma who are ineffective with conventional treatments such as high-dose corticosteroids, adding progesterone during treatment can improve the decline in premenstrual PEF and can reduce the daily hormone dose, which is helpful for treating severe asthma attacks before menstruation.

　　II. Prognosis

　　Most simple menstrual asthma patients do not have severe symptoms, and the prognosis is good. Only a few cases can be life-threatening, often occurring in patients with chronic asthma whose menstrual periods are exacerbated.