Syed A Shah1, Holly Tibble2, Rebecca Pillinger2, Susannah McLean2, Dermot Ryan3, Hilary Critchley4, David Price5, Catherine M Hawrylowicz6, Colin R Simpson7, Ireneous N Soyiri8, Francis Appiagyei9, Aziz Sheikh2, Bright I Nwaru10. 1. Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom. Electronic address: ahmar.shah@ed.ac.uk. 2. Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom. 3. Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom; Optimum Patient Care, Cambridge, United Kingdom. 4. Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom. 5. Optimum Patient Care, Cambridge, United Kingdom; Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom; Observational and Pragmatic Research Institute, Singapore. 6. Asthma UK Centre in Allergic Mechanisms of Asthma, School of Immunology and Microbial Sciences, Guys Hospital, Kings College London, London, United Kingdom. 7. Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom; School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, New Zealand. 8. Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom; Hull York Medical School, Institute for Clinical and Applied Health Research, University of Hull, Hull, United Kingdom. 9. Optimum Patient Care, Cambridge, United Kingdom. 10. Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom; Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Abstract
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 = 5.5-5.8) per 1,000 person years. Compared with nonuse of HRT, previous use of any (HR = 0.83; 95% CI = 0.76-0.88), estrogen-only (HR = 0.89; 95% CI = 0.84-0.95), or combined estrogen and progestogen (HR = 0.82; 95% CI = 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 = 0.79; 95% CI = 0.74-0.85), estrogen-only (HR = 0.80; 95% CI = 0.73-0.87), and combined estrogen and progestogen (HR = 0.78; 95% CI = 0.70-0.87) HRT. Longer duration of HRT use (1-2 years [HR = 0.93; 95% CI = 0.87-0.99]; 3-4 years [HR = 0.77; 95% CI = 0.70-0.84]; and ≥5 years [HR = 0.71; 95% CI = 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.
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 = 5.5-5.8) per 1,000 person years. Compared with nonuse of HRT, previous use of any (HR = 0.83; 95% CI = 0.76-0.88), estrogen-only (HR = 0.89; 95% CI = 0.84-0.95), or combined estrogen and progestogen (HR = 0.82; 95% CI = 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 = 0.79; 95% CI = 0.74-0.85), estrogen-only (HR = 0.80; 95% CI = 0.73-0.87), and combined estrogen and progestogen (HR = 0.78; 95% CI = 0.70-0.87) HRT. Longer duration of HRT use (1-2 years [HR = 0.93; 95% CI = 0.87-0.99]; 3-4 years [HR = 0.77; 95% CI = 0.70-0.84]; and ≥5 years [HR = 0.71; 95% CI = 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.
Authors: Erik Soeren Halvard Hansen; Kristian Aasbjerg; Amalie Lykkemark Moeller; Amani Meaidi; Elisabeth Juul Gade; Christian Torp-Pedersen; Vibeke Backer Journal: ERJ Open Res Date: 2022-03-21