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Oral contraceptive use linked to potential risk for lifetime asthma
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Oral contraceptive use was associated with higher prevalence of lifetime asthma, according to findings recently presented at the American Thoracic Society Annual Meeting.
“The impact of exogenous sex hormones on asthma severity is not well known,” Joe Zein, MD, of the pulmonology department at Cleveland Clinic told Healio Family Medicine. “Conflicting results have been published regarding the use of oral contraceptives in women in the child bearing age outside premenstrual asthma,” he added.
Zein and Jorge Morales-Estrella, MD, a second-year fellow at Cleveland Clinic, reviewed data for 6,524,990 women aged 20 to 50 years with a diagnosis of lifetime asthma who were treated with an inhaled corticosteroid or bronchodilator. Those with COPD or who had ever smoked were not included.
Researchers found that more than 2.1 million of the women used oral contraceptives and 692,470 had lifetime asthma. Asthma occurred more frequently in those who took oral contraceptives (14.3%) vs. those who did not (8.8%), and oral contraceptive use was linked to increased risk for asthma (adjusted OR = 1.77, 95% CI, 1.76-1.78).
The risk for asthma was also higher in women who were:
- Aged 20 to 29 years vs. those aged 30 to 39 years (aOR = 1.16; 95% CI, 1.15-1.17);
- Aged 40 to 49 years vs. those aged 30 to 39 years (aOR = 1.2; 95% CI, 1.19-1.21);
- Caucasian (adjusted OR = 1.17; 95% CI, 1.16-1.18) vs. other races;
- Had BMI between 25 and 30 kg/m2 vs. those with BMI between 18.5 and 25 kg/m2 (adjusted OR = 1.27; 95% CI, 1.26-1.28); and
- Had BMI greater than 30 kg/m2vs. those with BMI between 18.5 and 25 kg/m2 (adjusted OR = 1.67; 95% CI, 1.66-1.68).
“The surprising part was that, even if a subgroup of women with premenstrual asthma may benefit from oral contraceptives, exogenous hormonal supplementation may place women in the child bearing age at a higher risk for lifetime asthma,” Zein said in the interview.
This connection should be a consideration in clinical practice, he said.
“When dealing with women with severe asthma, physicians and other care givers should consider reviewing the patient’s birth control method and make recommendations if the use of oral contraceptives was found to be associated with worsening asthma symptoms and control, and loss in lung function,” Zein said.
“Primary care physicians should investigate whether there is a time relationship between starting women with asthma on oral contraceptives, and asthma becoming uncontrolled. In that case, other contraceptive methods should be considered. This does not mean that women with asthma should not be on oral contraceptives, or that women with premenstrual asthma would not benefit from oral contraceptives,” Zein continued. – by Janel Miller
Reference: Morales-Estrella J, Zein J. Oral contraception is associated with higher risk of lifetime asthma in women of reproductive age. Presented at: American Thoracic Society Annual Conference; May 18-23; San Diego.
Disclosures: Healio Family Medicine was unable to confirm relevant financial disclosures prior to publication.
Perspective
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Tania Elliott, MD, FAAAAI, FACAAI
Asthma prevalence is disproportionately greater in women than in men, and evidence suggests that female sex hormones may be playing a major role. It is well-established that upwards of 30% of women with asthma have a flare of symptoms during pregnancy, and that asthma exacerbations can flare with the menstrual cycle.
Estrogen receptors exist on immune cells and are thought to push these cells more towards an allergic phenotype. This study highlights that exogenous sex hormones may also play a role in the higher rate of asthma seen in women. The researchers looked at a dataset of more than 6 million women and, after adjusting for a number of factors including race and BMI, found that there may be a correlation with contraceptive use and a higher diagnosis of asthma than aged-matched cohorts. Additionally, an elevated BMI was also associated with asthma. Interestingly, adipose cells also produce estrogen, which may have had a compounding effect.
This study was observational in nature and did not account for other factors that could have been contributing to asthma development such as genetics, predisposition to allergic disease and the presence of comorbid conditions. These patients also were not followed over time to determine whether the diagnosis of asthma was in fact transient, or if symptoms resolved after discontinuing contraceptives.
Nonetheless, this study suggests the need for further evaluation of whether exogenous sex hormones contribute to asthma development and/or exacerbations.
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