Sub-clinical worsening of bronchial asthma during estrogen replacement therapy in asthmatic post-menopausal women

Lieberman, David; Kopernik, Gideon; Porath, Avi; Lazer, Simcha; Heimer, Dov

doi:10.1016/0378-5122(94)00890-j

Cited by 51 publications

(30 citation statements)

References 10 publications

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“…However, there are two case reports which suggest that they may make asthma worse [13,14]. These reports, however, are all about females with severe, difficult to control, asthma.…”

Section: Discussionmentioning

confidence: 93%

Do hormonal contraceptives influence asthma severity?

Forbes¹,

Jarvis²,

Burney³

1999

Eur Respir J

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There is some evidence that endogenous progesterone and oestrogen levels influence asthma severity in females, but little is known about the effects of hormonal contraceptives. This study aimed to describe how females with asthma perceived the effects of hormonal contraceptives on symptom severity, and to describe the association between asthma severity and current use of hormonal contraceptives.A questionnaire was sent to 891 females with asthma aged 20±30 yrs recruited from general practice registers in South London, UK. It asked about perceptions of the effects of hormonal contraceptives on asthma severity, about current use of hormonal contraceptives, and included an asthma quality of life questionnaire as a measure of asthma severity.About 6% of respondents who had ever used hormonal contraceptives reported that these had influenced asthma severity,~4% reporting worsening and 2% an improvement. There were no significant differences in asthma quality of life score between females currently taking hormonal contraceptives and those not, between those taking combined and progesterone-only preparations, or between users of different progestagen types.This study found no evidence of any important effect of hormonal contraceptives or their components on asthma severity in a group of females with relatively mild asthma. Eur Respir J 1999; 14: 1028±1033. Endogenous oestrogen and progesterone level may have an effect on asthma severity in females. About a third of females with asthma report worse symptoms in the perimenstrual part of their cycle [1±4]. In a study in the USA, a higher proportion of asthmatic females was admitted to hospital in the perimenstrual part of the cycle than at other times [5]. Studies of objective measures of asthma severity over the menstrual cycle are less consistent. Three studies found no difference in bronchial hyperresponsiveness (BHR) at two different times of the menstrual cycle [6±8], though the subjects may not have been representative of all asthmatic females, the sample sizes were small, and the times of the menstrual cycle chosen for measurement of BHR may not have been those most likely to show differences. In one study of 9 females, however, BHR increased in the luteal phase [9]. Because of the inconsistency between these studies, firm conclusions cannot be drawn about the effect of endogenous hormones on asthma severity in females.There is little published research on the effect of exogenous sex hormones on asthma and the results are also inconsistent. In the study by TAN et al. [9] the luteal phase increase in BHR was much smaller in 9 females taking oral contraceptive pills, suggesting a beneficial effect on asthma severity, though no differences in symptom outcomes were demonstrated. Some case reports and uncontrolled studies suggest that oestrogen or progesterone improve asthma symptoms or lung function [10±12] but others suggest that they might cause a deterioration [13± 15]. Females who had ever used hormone replacement therapy had a higher incidence of asthm...

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“…However, there are two case reports which suggest that they may make asthma worse [13,14]. These reports, however, are all about females with severe, difficult to control, asthma.…”

Section: Discussionmentioning

confidence: 93%

Do hormonal contraceptives influence asthma severity?

Forbes¹,

Jarvis²,

Burney³

1999

Eur Respir J

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“…It has been shown that asthma deteriorates during menses [1,27] and that postmenopausal women display contradictory reactions to estradiol replacement therapy [28,29]. Several reports in the literature describe complex relationships between female sex hormones and the hypothalamus-hypophysis-adrenal axis, including the postpartum period.…”

Section: Discussionmentioning

confidence: 99%

Regulation of Allergic Lung Inflammation in Rats: Interaction between Estradiol and Corticosterone

Oliveira

Oliveira‐Filho

Silva

et al. 2003

Neuroimmunomodulation

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Objective: One third of asthmatic women report a decreased expiratory peak flow during menses. Since asthma is characterized by lung inflammation and bronchopulmonary hyperresponsiveness, we investigated the role played by estradiol in allergic lung inflammation. Methods: Cell migration to the lungs of allergic female rats subjected to oophorectomy (OVx) was compared to that in their sham-operated (sham) control counterparts. Seven days after OVx or sham operation, the rats were sensitized intraperitoneally with ovalbumin (OA, 1 mg/kg) suspended in aluminum hydroxide (day 0). At day 7, a subcutaneous booster of OA was performed and an aerosolized OA challenge was carried out at day 14. One day later (day 15), the rats were killed and cell counts were performed in bronchoalveolar lavages (BAL), in peripheral blood and in bone marrow lavages. Results: After the antigen challenge, OVx rats showed a significant decrease in cell migration to the lung as compared to sham-operated rats. Differential analyses of BAL revealed a reduced number of eosinophils, mononuclear cells and neutrophils. In contrast, in bone marrow as well as in the peripheral blood the numbers of eosinophils, mononuclear cells and neutrophils were increased relative to sham controls. Mast cell numbers were similar in both groups. The estradiol receptor antagonist tamoxifen decreased the allergic lung inflammation in intact rats down to levels similar to those found in untreated OVx rats. In contrast, 17β-estradiol replacement in OVx rats reestablished the allergic lung inflammation, as observed by an elevated number of eosinophils, mononuclear cells and neutrophils recovered in BAL. Similarly, an elevated number of inflammatory cells were quantified in BAL from allergic OVx rats when corticosterone effects were blocked with metyrapone or RU-486. Conclusion: Our results suggest that estradiol has proinflammatory actions on the allergic lung response, and these actions seem to be mediated, at least in part, by endogenous glucocorticoids.

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“…In a small series of 20 postmenopausal women, Lieberman et al (124) described a significant reduction in PEFR and an increase in short-acting bronchodilator therapy after the initiation of estrogen therapy but failed to show a statistically significant change in FEV 1 . In comparison, Hepburn et al (123) evaluated 20 postmenopausal women with asthma actively taking estrogen replacement.…”

Section: Menopause and Exogenous Estrogen Replacementmentioning

confidence: 96%

“…The effects of estrogen replacement therapy in postmenopausal women with existing asthma have been explored, but the results are inconsistent (123,124). In a small series of 20 postmenopausal women, Lieberman et al (124) described a significant reduction in PEFR and an increase in short-acting bronchodilator therapy after the initiation of estrogen therapy but failed to show a statistically significant change in FEV 1 .…”

Section: Menopause and Exogenous Estrogen Replacementmentioning

confidence: 98%

Sex Differences in Asthma

McCallister

Mastronarde

2008

Journal of Asthma

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Asthma is a common chronic pulmonary disease whose prevalence varies greatly with the sex and age of the patient. Research has shown that men and women may experience this disease differently, although these sex-related differences have not routinely translated into differences in clinical care for patients with asthma. This review explores some of the major differences in asthma between men and women and some of the main hypotheses developed to explain them.

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Sub-clinical worsening of bronchial asthma during estrogen replacement therapy in asthmatic post-menopausal women

Cited by 51 publications

References 10 publications

Do hormonal contraceptives influence asthma severity?

Do hormonal contraceptives influence asthma severity?

Regulation of Allergic Lung Inflammation in Rats: Interaction between Estradiol and Corticosterone

Sex Differences in Asthma

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