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Asthma Risk Increase With Hrt

Hormone replacement therapy appears to worsen asthma, especially in women who had asthma before menopause.

The causal link between estrogen use and exacerbation of asthma is preliminary, but it is suggestive enough to warrant stopping hormone replacement therapy (HRT) in women with severe or uncontrolled asthma.

The finding came from a study of 2,757 postmenopausal women who had confirmed asthma, part of the 121,701 women enrolled in the Nurses' Health Study.

Of the women with asthma, 23% reported current use of estrogen, 18% reported current use of combined estrogen and progestin, 19% reported past use of HRT, and 40% reported no HRT use.

In addition, 65% of the women had their asthma diagnosed before menopause.

Among women who had asthma before menopause, following menopause the risk of hospitalization or need for an urgent hospital visit for asthma was an average 80% higher among women taking estrogen, compared with those who had no HRT. This difference was statistically significant, reported Dr. Barr of Columbia-Presbyterian Medical Center in New York City.

Women who used a combination of estrogen plus progestin had a 50% increased risk of hospitalization or urgent visit for asthma, compared with nonusers, a difference that just missed being statistically significant.

The results from randomized, controlled studies now in progress may further address whether HRT worsens pre existing asthma.

In a prior analysis of 43,000 post-menopausal women in the Nurses' Health Study Dr. Barr and his associates found that estrogen boosted a woman's risk of developing adult-onset asthma by 80%. Combination estrogen and progestin increased the risk of late-onset asthma by 60%. Earlier findings also showed that the severity of asthma in pre-menopausal women varied based on the menstrual cycle.

Estrogen is a proinflammatory agent that raises mast cell activity, effects that may mediate an estrogen-asthma link. Estrogen also triggers airway edema. Progestin probably blunts these effects, Dr. Barr said.

But HRT does not affect all aspects of lung function; it does not change the severity of chronic obstructive pulmonary disease, he said.

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