DEAR DR. ROACH: I’m a 55-year-old perimenopausal woman who developed asthma a few years ago. My symptoms always start right before my menstrual cycle. My doctor ruled out allergies as the cause. I used to get colds and sinus infections premenstrually in my younger years. Most medical practitioners don’t see the correlation between hormones and respiratory symptoms.

I sometimes take 10 mg of prednisone when I’m wheezing more than usual, and it seems to help. Is this dose putting me at risk for diabetes if taken regularly? — B.S.

ANSWER: Perimenstrual asthma is a well-recognized condition that is nevertheless not well-known by most nonexperts. It is less likely to be caused by allergies and more likely to be aspirin-sensitive — meaning that aspirin, or other anti-inflammatory drugs (like ibuprofen) commonly taken by women during menstruation, can trigger an asthma attack. Maybe a quarter of women with asthma have perimenstrual asthma. As you say, it is thought to be the hormone changes around menstruation that trigger the asthma.

Oral contraceptives used continuously prevent large changes in progesterone and estradiol, and may be helpful in managing perimenstrual asthma. Although I didn’t find a lot about it in literature, I suspect that when your periods stop, your asthma symptoms will get better.

Increased medication at the time of menses is frequently needed. However, because prednisone, even at the fairly small dose of 10 mg, does increase risk of diabetes, osteoporosis, high blood pressure, glaucoma, cataracts and many other conditions, oral prednisone is not my first choice for medication in this situation.

Inhaled steroids would be one choice, but they take a while to begin working. One recommended treatment is the oral medicine montelukast (Singulair), which has been proven effective in a small study and starts working right away.

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1. ROACH WRITES: A recent column regarding a “tip jar” in a living situation for a reader’s brother who had suffered a stroke generated very powerful responses. (Respondents included nurses and administrators who worked in care facilities.) Many readers noted that they thought this was illegal in the states they lived in. While many readers responded that they were happy to give gifts to the caregivers, nearly every person wrote that the public nature of the “tip jar” was inappropriate.

The institutions I have been affiliated with have very careful rules about accepting any kind of gift. In my opinion, the “tip jar” grossly violated ethical standards, and nearly all readers agreed with me.

Several readers wished me to mention the state ombudsman program for long-term care. Every state is required to have such a program to address complaints and advocate for improvements. Residents in the U.S. can learn more about the long-term care ombudsman program at ltcombudsman.org/about/about-ombudsman.

Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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