Hormone Replacement Therapy and Risk of Severe Asthma Exacerbation in Perimenopausal and Postmenopausal Women: 17-Year National Cohort Study

Bright I. Nwaru* (Corresponding Author), Syed A. Shah, Holly Tibble, Rebecca Pillinger, Susannah McLean, Dermot Ryan, Hilary Critchley, Catherine M. Hawrylowicz, Colin R. Simpson, Ireneous N. Soyiri, Francis Appiagyei, David Price, Aziz Sheikh

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Background The impact of hormone replacement therapy (HRT) on clinical outcomes in menopausal women is uncertain. Objective To investigate the association between use of HRT and severe asthma exacerbation in perimenopausal and postmenopausal women with asthma. Methods We used the Optimum Patient Care Research Database, a population-based longitudinal primary care database in the United Kingdom, to construct a 17-year (January 1, 2000, to December 31, 2016) cohort of perimenopausal and postmenopausal (46-70 years, N = 31,656) women. We defined use of HRT, its subtypes, and duration of HRT use. Severe asthma exacerbation was defined as an asthma-related hospitalization, emergency department visits due to asthma, and/or prescription of oral corticosteroids. Analyses were undertaken using multilevel mixed-effects Poisson regression. Results At baseline, 22% of women were using any HRT, 11% combined HRT, and 11% estrogen-only HRT. Previous, but not current, use of any (incidence rate ratio [IRR]: 1.24, 95% confidence interval [CI]: 1.22-1.26), combined (IRR: 1.28, 95% CI: 1.25-1.31), and estrogen-only HRT (IRR: 1.18, 95% CI: 1.14-1.21), and longer duration (1-2 years: IRR: 1.16, 95% CI: 1.13-1.19; 3-4 years: IRR: 1.43, 95% CI: 1.38-1.48; 5+ years: IRR: 1.32, 95% CI: 1.28-1.36) of HRT use were associated with increased risk of severe asthma exacerbation compared with nonuse. The risk estimates were greater among lean women (body mass index [BMI]
Original languageEnglish
Pages (from-to)2751-2760.e1
Number of pages10
JournalThe Journal of Allergy and Clinical Immunology: In Practice
Issue number7
Early online date8 Mar 2021
Publication statusPublished - Jul 2021

Bibliographical note

This work was supported by Asthma UK, grant number: AUK-IG-2016-346 and Health Data Research UK. We thank Optimum Patient Care (OPC) and Observational and Pragmatic Research Institute Pte Ltd (OPRI) for making the OPCRD database (www.opcrd.co.uk) available free of charge. B. I. Nwaru acknowledges the support of Knut and Alice Wallenberg Foundation, the Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Sweden, and the VBG Group Herman Krefting Foundation on Asthma and Allergy. A. Sheikh acknowledges support of Health Data Research UK (BREATHE).


  • Asthma exacerbation
  • Combined hormone therapy
  • Estrogen-only therapy
  • Hormone replacement therapy
  • Menopause
  • Women
  • Cohort study


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