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Asthma
Hormone replacement therapy, body mass index and asthma in perimenopausal women: a cross sectional survey
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  1. F Gómez Real1,2,
  2. C Svanes2,3,
  3. E H Björnsson4,
  4. K Franklin5,
  5. D Gislason4,
  6. T Gislason4,
  7. A Gulsvik2,3,
  8. C Janson6,
  9. R Jögi7,
  10. T Kiserud1,10,
  11. D Norbäck6,
  12. L Nyström8,
  13. K Torén9,
  14. T Wentzel-Larsen11,
  15. E Omenaas3,11
  1. 1Department of Gynecology and Obstetrics, Haukeland University Hospital, 5021 Bergen, Norway
  2. 2Institute of Medicine, University of Bergen, Norway
  3. 3Department of Thoracic Medicine, Haukeland University Hospital, 5021 Bergen, Norway
  4. 4Department of Pulmonary Medicine, Landspitali University Hospital, 105 Reykjavik, Iceland
  5. 5Department of Pulmonary Medicine and Allergology, Umeå University, 90185 Umeå, Sweden
  6. 6Department of Medical Sciences, Uppsala University, 75185 Uppsala, Sweden
  7. 7Foundation Tartu University Clinics, Lung Clinic, 51014 Tartu, Estonia
  8. 8Department of Public Health, Clinical Medicine and Epidemiology, Umeå University, 90185 Umeå, Sweden
  9. 9Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, 41266 Gothenburg, Sweden
  10. 10Institute of Clinical Medicine, University of Bergen, Norway
  11. 11Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
  1. Correspondence to:
    Dr F Gómez Real
    Department of Gynecology and Obstetrics, Haukeland University Hospital, 5021 Bergen, Norway; francisco.real{at}med.uib.no

Abstract

Background: Hormone replacement therapy (HRT) and obesity both appear to increase the risk of asthma. A study was undertaken to investigate the association of HRT with asthma and hay fever in a population of perimenopausal women, focusing on a possible interaction with body mass index (BMI).

Methods: A postal questionnaire was sent to population based samples in Denmark, Estonia, Iceland, Norway, and Sweden in 1999–2001, and 8588 women aged 25–54 years responded (77%). Pregnant women, women using oral contraceptives, and women <46 years were excluded. Analyses included 2206 women aged 46–54 years of which 884 were menopausal and 540 used HRT. Stratified analyses by BMI in tertiles were performed.

Results: HRT was associated with an increased risk for asthma (OR 1.57 (95% CI 1.07 to 2.30)), wheeze (OR 1.60 (95% CI 1.22 to 2.10)), and hay fever (OR 1.48 (95% CI 1.15 to 1.90)). The associations with asthma and wheeze were significantly stronger among women with BMI in the lower tertile (asthma OR 2.41 (95% CI 1.21 to 4.77); wheeze OR 2.04 (95% CI 1.23 to 3.36)) than in heavier women (asthma: pinteraction = 0.030; wheeze: pinteraction = 0.042). Increasing BMI was associated with more asthma (OR 1.08 (95% CI 1.05 to 1.12) per kg/m2). This effect was only found in women not taking HRT (OR 1.10 (95% CI 1.05 to 1.14) per kg/m2); no such association was detected in HRT users (OR 1.00 (95% CI 0.92 to 1.08) per kg/m2) (pinteraction = 0.046). Menopause was not significantly associated with asthma, wheeze, or hay fever.

Conclusions: In perimenopausal women there is an interaction between HRT and BMI in the effects on asthma. Lean women who were HRT users had as high a risk for asthma as overweight women not taking HRT. It is suggested that HRT and overweight increase the risk of asthma through partly common pathways.

  • BMI, body mass index
  • ECRHS, European Community Respiratory Health Survey
  • HRT, hormone replacement therapy
  • IR, insulin resistance
  • RHINE, Respiratory Health in Northern Europe
  • asthma
  • menopause
  • hormone replacement therapy
  • body mass index

https://doi.org/10.1136/thx.2005.040881

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    Footnotes

    • Published Online First 21 October 2005

    • FGR was supported by a grant from the Norwegian Research Council. The study was supported financially by the Icelandic Research Council, the Swedish Heart and Lung Foundation, the Vårdal Foundation for Health Care Science and Allergy Research, the Swedish Association against Asthma and Allergy, the Norwegian Research Council project 135773/330, the Norwegian Asthma and Allergy Association, the Danish Lung Association, and the Estonian Science Foundation grant no 4350.

    • Competing interests: none.

    • The study was approved by local ethics committees in all the study centres.

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