What is known about the use of contraceptives and worsening of asthma symptoms?/nA woman treated wi

Fråga: What is known about the use of contraceptives and worsening of asthma symptoms?

A woman treated with Desolett since April 1996 has noticed that her asthma has become worse.

Sammanfattning: Information concerning oral contraceptive use and exacerbation of asthma symptoms is scarce. A follow-up study indicates that there may be a higher risk of asthma symptoms when women are treated with oral contraceptives. No difference in airway responsiveness was found in a clinical study of asthmatic women on hormonal therapy. A few case reports indicate that there is a possible cause-effect relationship between development of bronchial symptoms and use of oral contraceptives. In the present case one cannot exclude the possibility of a cause-effect relationship.

Svar: Desolett is an oral contraceptive which contains the active substances gestagen, desogestrel 150 ug and oestrogen, ethinyloestradiol 30 ug (1). Asthma is the most common drug induced respiratory disease following a great number of different drugs (2). Exacerbation of asthma is not mentioned as an adverse effect during treatment with Desolett (1).

An updated Medline search revealed a prospective cohort study that has evaluated hormone replacement therapy and asthma incidence of pre- and postmenopausal women 34 to 68 years of age (3). During 10 years of follow-up, about 41000 pre- and 36000 post-menopausal women were included in the study. The results showed that postmenopausal women had a significantly lower risk of asthma (relative risk 0.65) than premenopausal women of the same age. Postmenopausal women on hormon therapy had a moderately greater risk (relative risk 1.5) compared with those women that did not receive such therapy (conjugated oestrogens with or without progesteron). The dose was also positively associated with the asthma risk, and the highest risk of asthma was found among women taking hormones for 10 years or more.

The literature on oral contraceptive use and asthma seems to be sparse. We found a case report published in the late 1960´s. It notes the development of bronchial symptoms in a woman who began taking oral contraceptives four years earlier. The symptoms subsided after discontinuation (4).

More recently a clinical study of seven asthmatic women using oral contraceptives found no difference in airway responsiveness measured within one week of completing a 21-day course. Also after start of menstruation but before restarting medication no difference in spirometry was found. Despite this, asthmathic symptoms were worse during menstruation irrespective of using progesterone containing contraceptives or not. Changes in symptoms were demonstrated not to be related to serum progesterone levels or airway responsiveness (5).

The WHO database contains in total ten cases in which asthma symptoms have been judged as a possible or probable effect of treatment with a combination of gestagen and oestrogen.

A search in Drugline and pharmacological handbooks gave no further information. We suggest this case be reported to SADRAC. 1 FASS 1996 2 Lung disease caused by drugs. Br Med J 1969; 3: 729-730 3 Troisi RJ, Speizer FE, Willett WC, Trichopoulos D, Rosner B: Menopause, postmenopausal estrogen preparations, and the risk of adult-onset asthma. Am J Respir Crit Care Med 1995; 152: 1183-1188 4 Horan JD, Lederman JJ: Possible asthmogenic effect of oral contraceptives. Canad Med Ass J 1968; 99: 130-131 5 Juniper EF, Kline PA, Roberts RS, Hargreave FE, Daniel EE: Aurway responsiveness to methacholine during the natural menstrual cycle and the effect of oral contraceptives. Am Rev Respir Dis 1987; 135: 1039-1042