Hormone Replacement Therapy and Asthma Onset in Menopausal Women: National Cohort Study

Syed Ahmar Shah, Holly Tibble, Rebecca Pillinger, Susannah McLean, Dermot Ryan, Hilary Critchley, David Price, Catherine M Hawrylowicz, Colin R Simpson, Ireneous N Soyiri, Francis Appiagyei, Aziz Sheikh, Bright Nwaru

Research output: Contribution to journalArticlepeer-review

Abstract

Background: There is uncertainty about the role of hormonal replacement therapy (HRT) in development of asthma.
Objective: We investigated whether use of HRT and duration of use was associated with risk of developing asthma in peri- and post-menopausal women.
Methods: We constructed a 17-year (1/1/2000 – 12/31/2016) open cohort of 353,173 women (46-70 years old) from the Optimum Patient Care Database, a longitudinal primary care database from across UK. HRT use, subtypes, and duration of use; confounding variables; and asthma onset were defined using the Read Clinical Classification System. We fitted multilevel Cox regression models to estimate hazard ratios (HR) with 95% confidence intervals (CIs).
Results: During 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 to non-use 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), and combined estrogen/progestogen (HR 0.82; 95%CI 0.76-0.88) HRT were 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/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; 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 developing late onset asthma in menopausal women. Further cohort studies are needed to confirm these findings.
Original languageEnglish
JournalJournal of Allergy and Clinical Immunology
Early online date3 Dec 2020
DOIs
Publication statusE-pub ahead of print - 3 Dec 2020

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