Do hormonal contraceptives influence asthma severity (original) (raw)
Related papers
2020
FUNDING: This work was supported by Asthma UK, grant number: AUK-IG-2016-346 and Health Data Research UK. We thank Optimum Patient Care (OPC) and Observational and Pragmatic Research Institute Pte Ltd (OPRI) for making the OPCRD database (www.opcrd.co.uk) available free of charge. BN acknowledges the support of Knut and Alice Wallenberg Foundation, the Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden, and the VBG Group Herman Krefting Foundation on Asthma and Allergy. AS acknowledges support of Health Data Research UK (BREATHE). ACKNOWLEDGEMENTS: We would like to thank Dr Lynn Morrice for administrative assistance and members of the Patient and Public Involvement group of the Asthma UK Centre for Applied Research who helped shape this project during the grant application stage. We also thank Dr Susannah McLean who helped with selection of Read codes and design of strategy for determining start and end dates of pregnancies. We are grateful ...
Thorax, 2020
BackgroundLongitudinal studies investigating impact of exogenous sex steroids on clinical outcomes of asthma in women are lacking. We investigated the association between use of hormonal contraceptives and risk of severe asthma exacerbation in reproductive-age women with asthma.MethodsWe used the Optimum Patient Care Research Database, a population-based, longitudinal, anonymised primary care database in the UK, to construct a 17-year (1 January 2000–31 December 2016) retrospective cohort of reproductive-age (16–45 years, n=83 084) women with asthma. Using Read codes, we defined use, subtypes and duration of use of hormonal contraceptives. Severe asthma exacerbation was defined according to recommendations of the European Respiratory Society/American Thoracic Society as asthma-related hospitalisation, accident and emergency department visits due to asthma and/or oral corticosteroid prescriptions. Analyses were done using multilevel mixed-effects Poisson regression with QR decomposit...
Exogenous Female Sex Steroid Hormones and New-Onset Asthma in Women: A Matched Case-Control Study
Research Square (Research Square), 2022
Background Evidence on the role of exogenous female sex steroid hormones in asthma development in women remains conflicting. We sought to quantify the potential causal role of hormonal contraceptives and menopausal hormone therapy (MHT) in the development of asthma in women. Methods We conducted a matched case-control study based on the West Sweden Asthma Study, nested in a representative cohort of 15,003 women aged 16-75 years, with 8year follow-up (2008-2016). Data were analyzed using Frequentist and Bayesian conditional logistic regression models. Results We included 114 cases and 717 controls. In Frequentist analysis, the odds ratio (OR) for new-onset asthma with ever use of hormonal contraceptives was 2.13 (95% confidence interval [CI] 1.03-4.38). Subgroup analyses showed that the OR increased consistently with older baseline age. The OR for new-onset asthma with ever MHT use among menopausal women was 1.17 (95% CI 0.49-2.82). In Bayesian analysis, the ORs for ever use of hormonal contraceptives and MHT were, respectively, 1.11 (95% posterior interval [PI] 0.79-1.55) and 1.18 (95% PI 0.92-1.52). The respective probability of each OR being larger than 1 was 72.3% and 90.6%. 4 Conclusions Although use of hormonal contraceptives was associated with an increased risk of asthma, this may be explained by selection of women by baseline asthma status, given the upward trend in the effect estimate with older age. This indicates that use of hormonal contraceptives may in fact decrease asthma risk in women. Use of MHT may increase asthma risk in menopausal women.
Do exogenous oestrogens and progesterone influence asthma
Thorax, 1999
Between 20% and 40% of women of childbearing age in the UK use hormonal contraceptives. 1 2 In a survey carried out in Oxfordshire in 1990 about 20% of women aged 45-64 years were taking hormone replacement therapy (HRT). 3 Around 5% of women of childbearing age in the UK have diagnosed asthma, and a higher proportion have asthmalike symptoms. There is less information available about the prevalence of asthma in older women, but there is little doubt that it is a common problem in this age group also.
Thorax, 2001
Background-Recent evidence suggests a role for hormonal factors in the aetiology of asthma. Methods-Data from a large study of women selected from the general population were used to relate treatment with oral hormonal contraceptives (OCP) and postmenopausal hormone replacement therapy (HRT) to the following asthma indicators: self-reported asthma, wheezing, cough at exertion, and use of medication for asthma. The study sample comprised 1536 premenopausal and 3016 postmenopausal women who participated in the third round of the Copenhagen City Heart Study in 1991-4. A total of 377 women were taking OCP (24.5% of premenopausal women) and 458 were on HRT (15.2% of postmenopausal women). Results-In premenopausal women 4.8% reported having asthma. The prevalence of self-reported asthma, wheeze, use of asthma medication, and cough at exertion was not significantly related to use of OCP. In postmenopausal women the prevalence of self-reported asthma was 6.2%. A weak but consistent association was observed between HRT and self-reported asthma (OR 1.42 (95% CI 0.95 to 2.12)), wheeze (OR 1.29 (95% CI 1.02 to 1.64)), cough at exertion (OR 1.34 (95% CI 1.01 to 1.77)), and use of asthma medication (OR 1.45 (95% CI 0.97 to 2.18)). Conclusions-In this study of the general population no relationship was found between the use of OCP and asthma. Although an association was observed between HRT and asthma and asthmalike symptoms, this was relatively weak and it is concluded that there is no necessity to change present prescription practice. (Thorax 2001;56:613-616)
Exogenous female sex steroid hormones and risk of asthma and asthma-like symptoms
Thorax
Background-Recent evidence suggests a role for hormonal factors in the aetiology of asthma. Methods-Data from a large study of women selected from the general population were used to relate treatment with oral hormonal contraceptives (OCP) and postmenopausal hormone replacement therapy (HRT) to the following asthma indicators: self-reported asthma, wheezing, cough at exertion, and use of medication for asthma. The study sample comprised 1536 premenopausal and 3016 postmenopausal women who participated in the third round of the Copenhagen City Heart Study in 1991-4. A total of 377 women were taking OCP (24.5% of premenopausal women) and 458 were on HRT (15.2% of postmenopausal women). Results-In premenopausal women 4.8% reported having asthma. The prevalence of self-reported asthma, wheeze, use of asthma medication, and cough at exertion was not significantly related to use of OCP. In postmenopausal women the prevalence of self-reported asthma was 6.2%. A weak but consistent association was observed between HRT and self-reported asthma (OR 1.42 (95% CI 0.95 to 2.12)), wheeze (OR 1.29 (95% CI 1.02 to 1.64)), cough at exertion (OR 1.34 (95% CI 1.01 to 1.77)), and use of asthma medication (OR 1.45 (95% CI 0.97 to 2.18)). Conclusions-In this study of the general population no relationship was found between the use of OCP and asthma. Although an association was observed between HRT and asthma and asthmalike symptoms, this was relatively weak and it is concluded that there is no necessity to change present prescription practice. (Thorax 2001;56:613-616)
Parity and decreased use of oral contraceptives as predictors of asthma in young women
Clinical <html_ent glyph="@amp;" ascii="&"/> Experimental Allergy, 2006
Background Asthma is more prevalent among males in childhood, but females report higher rates in adulthood. The reasons are unknown; although it has been hypothesized that hormonal factors may explain this sex-dependent risk of adult-onset asthma. Objective To determine whether a woman's reproductive history or use of oral contraceptives is associated with adult-onset asthma. Methods In 1991-1993, we surveyed 681 women aged 29-32 years randomly sampled from participants first surveyed at age 7 years by the 1968 Tasmanian Asthma Survey, a study of all children born in 1961 and attending school. Current asthma was defined as reporting asthma or wheezy breathing in the past 12 months. Results In women who did not have asthma or wheezy breathing by age 7 years, 13% had current asthma. The risk of current asthma in these who were parous increased with the number of births (odds ratio (OR) 1.50 per birth, 95% confidence interval (CI) 1.01-2.23 P = 0.04) while women with one birth were at a lower risk than nulliparous women (OR 0.46 95% CI 0.2-1.06, P = 0.07). Independent of parity, the risk decreased by 7% (95% CI 0-13%) per year of oral contraceptive pill use in all women. In women who did have asthma or wheezy breathing by age 7 years, neither reproductive history nor oral contraceptive pill use predicted current asthma. Conclusion Our observation that parity and decreased oral contraceptive use predict asthma in women, is consistent with the hypothesis that the asthma that develops after childhood is in part a response to endogenous and exogenous female hormones. This may be due to alterations of cytokine responses by the pregnant state, triggering adult-onset asthma in women.
The Journal of allergy and clinical immunology, 2018
Endogenous and exogenous sex steroid hormones in asthma and allergy in females: A systematic review and meta-analysis To the Editor: Asthma and allergy are more common in males than in females during early childhood, but the incidence, severity, and impact on quality of life are greater in postpubertal females than in males. 1,2 Female sex steroid hormones may partly explain these differences. 1,2 In 2 previous systematic reviews, early menarche (<12 years) was associated with an increased asthma risk, 3 whereas no significant association was found between menopause and asthma, although subgroup analyses indicated an increased risk in postmenopausal women using hormone replacement therapy (HRT). 4 Consideration of other hormonal factors, along with the full spectrum of relevant outcomes, is necessary for a comprehensive appreciation of the underlying evidence base. We therefore undertook a systematic review investigating the role of endogenous and exogenous hormonal factors in the development and clinical expression of asthma and allergy in females. Our methods were published a priori (PROSPERO: 2015:CRD42015026762). 5 Further details are available in this article's Online Repository at www.jacionline.org. We included experimental and analytical epidemiological studies of females from puberty to adulthood (<75 years). Exposures were puberty, menarche, menstruation, menopause, hormonal contraceptives, and HRT. Primary outcomes were self-reported or objectively defined incidence or prevalence of asthma, asthma exacerbations, asthma hospitalizations, and asthma medication use. We searched 11 bibliographic databases, databases of ongoing studies, and conference abstracts, and contacted experts for articles published between January 1990 and November 2015 with no language restrictions. N.M. and B.I.N. independently screened titles, abstracts, and full-text articles; extracted study data; and assessed risk of bias using the Cochrane Risk of Bias Tool (experimental studies) and the Effective Public Health Practice Project tool (observational studies). Discrepancies were resolved by discussion, or arbitration by A.S. Adjusted effect estimates were combined in random-effects meta-analyses, performed using Stata release 14 (StataCorp, College Station, Tex). Meta-analyses were possible for studies on menarche, menstruation, menopause, hormonal contraceptives, and HRT. Stratified analyses were performed by body mass index and smoking for HRT studies. Of 22,488 articles retrieved, 64 (reporting 57 studies; observational: 51; experimental: 6) were included with 554,293 participants analyzed (see references E5 and E10-E72 and Fig E1 in this article's Online Repository at www.jacionline.org). Study characteristics are available on request. Detailed results are given in this article's Online Repository at www.jacionline.org; here, we present key findings. Compared with typical menarche (11-13 years), early menarche (<11 years) was associated with increased risk of new-onset (odds ratio [OR], 1.49; 95% CI, 1.14-1.94) and ever asthma (OR, 1.06; 95% CI, 1.03-1.10), whereas late menarche (>13 years) was associated with increased risk of ever (OR, 1.11; 95% CI, 1.07-1.15), but not new-onset asthma (OR, 1.13; 95% CI, 0.82-1.56) (Fig 1). Compared with regular menstruation, irregular menstruation was associated with increased risk of current asthma (past 12 months) (OR, 1.59; 95% CI, 1.23-2.05) (see Fig E2, A, in this article's Online Repository at www.jacionline.org), specifically for atopic (OR, 2.57; 95% CI, 1.66-3.98), but not nonatopic asthma (OR, 0.95; 95% CI, 0.54-1.65) (Fig E2, B). Compared with premenopause, menopause onset was associated with increased risk of current asthma (OR, 1.25; 95% CI, 1.04-1.51) and current wheeze (OR, 1.16; 95% CI, 1.05-1.30), but not current allergic rhinitis (OR, 0.94; 95% CI, 0.81-1.10) (see Fig E3 in this article's Online Repository at www.jacionline.org). Results for hormonal contraceptives were mixed, with both increased and decreased risks reported (Fig E3).
Estradiol in Premenstrual Asthma: A Double-Blind, Randomized, Placebo-Controlled, Crossover Study
Pharmacotherapy, 2003
To characterize asthma symptoms and pulmonary function throughout two menstrual cycles, with and without exogenous estradiol administration, in women with premenstrual asthma, and to determine the effect of estradiol administration on asthma symptoms, pulmonary function, quality of life, and biomarkers of airway inflammation. Design. Double-blind, randomized, placebo-controlled, crossover study. Setting. Respiratory clinic and clinical research center. Subjects. Twelve women with documented premenstrual asthma (≥ 20% premenstrual worsening of asthma symptoms and/or of peak expiratory flow [PEF] during a 1-month screening phase). Intervention. Each woman received either estradiol 2 mg or placebo orally between cycle days 23 and 28 (i.e., premenstrually, or before the onset of menses) in the first cycle and then crossed over to the other arm in the second cycle. Throughout both cycles, the women recorded daily morning and evening PEF readings and asthma symptoms. Measurements and Main Results. Spirometry testing and measurement of serum estradiol and biomarkers of airway inflammation were performed on days 8 (follicular phase), 22 (luteal phase), and 28 (premenstrually) of both the estradiol and placebo cycles. During the two premenstrual visits, the Asthma Quality of Life Questionnaire was administered. No notable differences were observed between the estradiol and placebo cycles in daily PEF recordings or composite asthma symptoms scores. The area under the curve (AUC) for the composite asthma symptoms versus time profile was numerically, but not statistically, lower (denoting less severe symptoms) during the estradiol cycle than during the placebo cycle. Likewise, no significant difference in AUC values for morning PEF or evening PEF was found between the estradiol cycle and the placebo cycle. Despite differences (p<0.05) in day-28 estradiol concentrations for estradiol and placebo cycles, no significant differences were found in forced expiratory volume in 1 second, serum endothelin-1, serum and urine eosinophil protein X, urine leukotriene E 4 , or quality-of-life scores. Conclusion. Exogenously administered estradiol did not have a significant effect in women with premenstrual asthma whose asthma was classified predominantly as mild and under excellent control. As in the case of premenstrual syndrome, the placebo effect may be prominent in premenstrual asthma. Further trials, involving women with more severe asthma under poorer control, are warranted to discern underlying mechanisms for the worsening of asthma in relation to menstruation. (Pharmacotherapy 2003;23(5):561-571)
Hormone replacement therapy and asthma onset in menopausal women: National cohort study
Journal of Allergy and Clinical Immunology, 2021
Background: There is uncertainty about the role of hormonal replacement therapy (HRT) in the development of asthma. Objective: We investigated whether use of HRT and duration of use was associated with risk of development of asthma in perimenopausal and postmenopausal women. Methods: We constructed a 17-year (from January 1, 2000, to December 31, 2016) open cohort of 353,173 women (aged 46-70 years) from the Optimum Patient Care Database, a longitudinal primary care database from across the United Kingdom. HRT use, subtypes, and duration of use; confounding variables; and asthma onset were defined by using the Read Clinical Classification System. We fitted multilevel Cox regression models to estimate hazard ratios (HRs) with 95% CIs. Results: During the 17-year follow-up (1,340,423 person years), 7,614 new asthma cases occurred, giving an incidence rate of 5.7 (95% CI 5 5.5-5.8) per 1,000 person years. Compared with nonuse of HRT, previous use of any (HR 5 0.83; 95% CI 5 0.76-0.88), estrogen-only (HR 5 0.89; 95% CI 5 0.84-0.95), or combined estrogen and progestogen (HR 5 0.82; 95% CI 5 0.76-0.88) HRT was associated with a reduced risk of asthma onset. This was also the case with current use of any (HR 5 0.79; 95% CI 5 0.74-0.85), estrogen-only (HR 5 0.80; 95% CI 5 0.73-0.87), and combined estrogen and progestogen (HR 5 0.78; 95% CI 5 0.70-0.87) HRT. Longer duration of HRT use (1-2 years [HR 5 0.93; 95% CI 5 0.87-0.99]; 3-4 years [HR 5 0.77; 95% CI 5 0.70-0.84]; and > _5 years [HR 5 0.71; 95% CI 5 0.64-0.78]) was associated with a dose-response reduced risk of asthma onset. Conclusion: We found that HRT was associated with a reduced risk of development of late onset asthma in menopausal women. Further cohort studies are needed to confirm these findings. (J Allergy Clin Immunol 2020;nnn:nnn-nnn.)