More Bad News for HRT Use?

Despite the positive effects of hormone replacement therapy for treating menopause-related issues, HRT’s association with negative adverse outcomes has cast a dark shadow on it. Now, new research out of Europe shows that HRT also increases severe asthma attacks in patients. Dr Klaus Bnnelykke, from the faculty of health sciences at the University of Copenhagen and the Danish Pediatric Asthma Center at Copenhagen University Hospital in Demark, presented these findings at the European Respiratory Society’s Annual Congress in Amsterdam.

Bnnelykke and colleagues conducted a prospective study, leveraging HRT intake and confounding data from the Danish Diet, Cancer and Health cohort of 23,138 postmenopausal women and acute asthma and COPD hospitalization data from the validated Danish Hospital Discharge Register to explore the link between HRT and asthma. The researchers looked at effect modification with respect to smoking status and other comorbidities (eg, ischemic heart disease, other heart disease, stroke and diabetes).

Bnnelykke et al. found that 50.0% of all women had ever used HRT; they also noted a 1.9% incident of asthma hospitalizations over 9.9 years of mean follow-up. In their analysis, they determined HRT was indeed associated with asthma hospitalization, with a 1.37 hazard ratio (95% confidence interval). In addition, they found that women who had used HRT the longest had the highest risk of asthma-related hospitalization; women who used HRT for at least 10 years had a hazard ratio of 1.51 (Figure). Interestingly, Bnnelykke and colleagues found the highest hazard ratio (1.84) in patients who never smoked, and relatively no impact in women who were current smokes (hazard ratio=1.08). Hospitalization due to chronic obstructive pulmonary disease had a smaller impact (hazard ratio=1.19). When women with previous COPD hospitalization were excluded from the analysis, the association between HRT and asthma remained the same.
Figure. Hazard ratios (%) associated with years of HRT use

 
Prior research has shown that female sex hormones may play a role in the pathogenesis of asthma. And while previous studies have found a link between HRT use and asthma, this is the first study to show that HRT use can lead to severe exacerbation of asthma symptoms that in turn may lead to hospitalization.

“Our findings not only confirm this link [of HRT and asthma], but also extend this to severe asthma exacerbations” Bnnelykke explained to the press. “We still need the final proof from randomised trials, but we believe that the suspicion is now so strong that it should be brought to the attention of clinicians. If a patient develops asthma or has a severe worsening of symptoms after taking HRT, they may need to stop hormone therapy altogether.”

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References:

References: Bønnelykke K, Raaschou-Nielsen O, Bisgaard H, et al. Postmenopausal hormone therapy is associated with increased risk of asthma hospitalization. European Respiratory Society’s Annual Congress. Amsterdam. 2011.