Can exogenous oestradiol influence asthma symptoms?

Fråga: Can exogenous oestradiol influence asthma symptoms?

Sammanfattning: Premenopausal women have a higher risk of asthma, indicating a role of sex hormones in the pathogenesis of this disease. However, within the menstrual cycle, the greatest risk of asthma symptoms coincide with the premenstrual fall in hormonal levels. Here, oestrogen, or combined oestrogen-progesterone therapy, seems beneficial in a majority of patients. Postmenopausal women on hormonal replacement therapy seem to have a slightly increased asthma risk. On the other hand, oestrogen therapy may be of great importance in preventing osteoporosis, especially in corticosteriod treated asthmatic women.

Svar: The question concerning hormonal influence on asthma symptoms in women is complex and involve several different aspects, such as age and menstrual status of the patient.

In a large, prospective study including nearly 80000 women, 34 to 68 years of age, postmenopausal women had a significantly lower risk of asthma (relative risk 0.65) than premenopausal women of the same age. Postmenopausal women using oral hormone replacement therapy (conjugated oestrogens with or without progesterone) had a moderately increased risk (relative risk 1.5) compared to women with no hormonal therapy (1, 6).

Several studies support the idea that a worsening of symptoms can be seen premenstrually in asthmatic women, and that exogenous oestradiol or combined oral contraceptives ameliorates the symptoms in this phase of the menstrual cycle, by way of reducing the hormonal fluctuation (2-5). However, in a few cases, worsening of asthma symptoms have been connected to the use of oral contraceptives, according to a previous Drugline document (6).

Asthmatic women, both pre- and postmenopausal and with or without corticosteroid treatment, have been reported to have lower levels of sex hormones than healthy controls (7, 8). Also, the use of corticosteroids in the treatment of asthma greatly increases the risk of osteoporosis. Oestrogen supplementation may have important beneficial effects in these patients (9). However, we have found no literature evaluating the risk/benefit ratio of such treatment in asthmatic women.