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

Bright I. Nwaru; 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

doi:10.1016/j.jaip.2021.02.052

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 journal › Article › peer-review

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Abstract

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 language	English
Pages (from-to)	2751-2760.e1
Number of pages	10
Journal	The Journal of Allergy and Clinical Immunology: In Practice
Volume	9
Issue number	7
Early online date	8 Mar 2021
DOIs	https://doi.org/10.1016/j.jaip.2021.02.052
Publication status	Published - 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).

Keywords

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

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Nwaru, B. I., Shah, S. A., Tibble, H., Pillinger, R., McLean, S., Ryan, D., Critchley, H., Hawrylowicz, C. M., Simpson, C. R., Soyiri, I. N., Appiagyei, F., Price, D., & Sheikh, A. (2021). Hormone Replacement Therapy and Risk of Severe Asthma Exacerbation in Perimenopausal and Postmenopausal Women: 17-Year National Cohort Study. The Journal of Allergy and Clinical Immunology: In Practice, 9(7), 2751-2760.e1. https://doi.org/10.1016/j.jaip.2021.02.052

Hormone Replacement Therapy and Risk of Severe Asthma Exacerbation in Perimenopausal and Postmenopausal Women: 17-Year National Cohort Study. / Nwaru, Bright I. (Corresponding Author); Shah, Syed A.; Tibble, Holly et al.
In: The Journal of Allergy and Clinical Immunology: In Practice, Vol. 9, No. 7, 07.2021, p. 2751-2760.e1.

Research output: Contribution to journal › Article › peer-review

Nwaru, BI, Shah, SA, Tibble, H, Pillinger, R, McLean, S, Ryan, D, Critchley, H, Hawrylowicz, CM, Simpson, CR, Soyiri, IN, Appiagyei, F, Price, D & Sheikh, A 2021, 'Hormone Replacement Therapy and Risk of Severe Asthma Exacerbation in Perimenopausal and Postmenopausal Women: 17-Year National Cohort Study', The Journal of Allergy and Clinical Immunology: In Practice, vol. 9, no. 7, pp. 2751-2760.e1. https://doi.org/10.1016/j.jaip.2021.02.052

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

abstract = "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] ",

keywords = "Asthma exacerbation, Combined hormone therapy, Estrogen-only therapy, Hormone replacement therapy, Menopause, Women, Cohort study",

author = "Nwaru, {Bright I.} and Shah, {Syed A.} and Holly Tibble and Rebecca Pillinger and Susannah McLean and Dermot Ryan and Hilary Critchley and Hawrylowicz, {Catherine M.} and Simpson, {Colin R.} and Soyiri, {Ireneous N.} and Francis Appiagyei and David Price and Aziz Sheikh",

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).",

year = "2021",

month = jul,

doi = "10.1016/j.jaip.2021.02.052",

language = "English",

volume = "9",

pages = "2751--2760.e1",

journal = "The Journal of Allergy and Clinical Immunology: In Practice",

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publisher = "Elsevier",

number = "7",

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TY - JOUR

T1 - Hormone Replacement Therapy and Risk of Severe Asthma Exacerbation in Perimenopausal and Postmenopausal Women

T2 - 17-Year National Cohort Study

AU - Nwaru, Bright I.

AU - Shah, Syed A.

AU - Tibble, Holly

AU - Pillinger, Rebecca

AU - McLean, Susannah

AU - Ryan, Dermot

AU - Critchley, Hilary

AU - Hawrylowicz, Catherine M.

AU - Simpson, Colin R.

AU - Soyiri, Ireneous N.

AU - Appiagyei, Francis

AU - Price, David

AU - Sheikh, Aziz

N1 - 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).

PY - 2021/7

Y1 - 2021/7

N2 - 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]

AB - 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]

KW - Asthma exacerbation

KW - Combined hormone therapy

KW - Estrogen-only therapy

KW - Hormone replacement therapy

KW - Menopause

KW - Women

KW - Cohort study

U2 - 10.1016/j.jaip.2021.02.052

DO - 10.1016/j.jaip.2021.02.052

M3 - Article

SN - 2213-2198

VL - 9

SP - 2751-2760.e1

JO - The Journal of Allergy and Clinical Immunology: In Practice

JF - The Journal of Allergy and Clinical Immunology: In Practice

IS - 7

ER -

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

Abstract

Bibliographical note

Keywords

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