Hormone Replacement Therapy & Age Management Medicine: August 2021

Erin T. Welsh, MA

July 27, 2021 (Healio.com) — Hormone therapy with exogenous estrogen, with and without progesterone, may increase the risk for asthma in women, according to new research published in Chest.

“Because asthma is one of the most commonly encountered chronic conditions among women worldwide, we find it critically important to understand the relationship between asthma and hormone replacement therapy,” Erik Soeren Halvard Hansen, MD, from the Centre for Physical Activity Research at the University of Copenhagen in Denmark, and colleagues wrote. “General recommendations regarding duration and use of menopausal hormone replacement therapy already exist because of the well-known risk of cardiovascular disease and estrogen-dependent cancers. However, clear evidence is lacking regarding how hormone replacement therapy affects asthma incidence.”

Researchers conducted a nested case-control study of 34,533 women aged 40 to 65 years with asthma (mean age, 45.9 years) and 345,116 women without asthma (mean age, 45.8 years) from Danish registers from 1995 to 2018. An asthma diagnosis was defined as prescription of two inhaled corticosteroid within 2 years. Hormone therapy was defined as prescription of two female sex hormone within 6 months.

During the study observation period, 95,360 women received hormone therapy. Estrogen was the most common type of initial hormone therapy prescribed. Median length of treatment was 2.9 years.

The prevalence of hormone therapy was higher among those with asthma compared with those without asthma (34.4% vs. 24.2%; P < .001), according to the results.

Current hormone therapy use was associated with the development of a new asthma diagnosis after adjusting for age, household income and educational level therapying a multivariate analysis (HR = 1.63; 95% CI, 1.55-1.71; P < .001). Among these women, the median time from hormone therapy initiation to asthma diagnosis was 862 days.

In addition, women with asthma who discontinued hormone therapy had an increased likelihood of discontinuing their asthma treatment (HR = 2.12; 95% CI, 1.94-2.33; P < .001). Median time from therapy discontinuation to asthma treatment termination was 94 days, according to the results.

“Physicians prescribing hormone replacement therapy and women seeking menopausal treatment should be informed that airway symptoms can develop after initiation of hormone replacement therapy and in that event discontinuation should be considered,” the researchers wrote. “Prospective studies investigating the effect of hormone replacement therapy in women who already have asthma alongside mechanistic studies are warranted to determine how best to guide women seeking remedies for their menopausal symptoms.”