Hormonal Contraceptives May Cut Risk of Exacerbation in Women With Asthma

Dawn O'Shea

November 25, 2020

Taking the pill may cut the risk of severe bouts of asthma in women of reproductive age, finds a large long-term study published online in  Thorax.

A team of researchers in Sweden and the UK investigated the association between use of hormonal contraceptives and risk of severe asthma exacerbation in reproductive-age women with asthma.

They used the population-based, longitudinal, anonymised Optimum Patient Care Research Database to construct a 17-year retrospective cohort of reproductive-age (16-45 years) women with asthma (n=83,084). The 17-year follow-up resulted in 456,803 person-years of follow-up time.

At baseline, just over a third (34%) of women were using any hormonal contraceptives, 25 per cent combined oestrogen/progestogen contraceptives and 9 per cent progestogen-only contraceptives.

The proportion of women who had bouts of severe asthma rose with increasing age and BMI and a higher number of previous pregnancies. It was also higher in ex- and current smokers than in non-smokers and among women who had had a gynaecological condition.

After taking account of these potentially influential factors, previous and current use of any and combined hormonal contraceptives was associated with a lower, albeit relatively small, risk of severe asthma bouts compared with no use at all.

Previous (incidence rate ratio [IRR], 0.94; 95% CI, 0.92-0.97) and current (IRR, 0.96; 95% CI, 0.94-0.98) use of any contraceptive and previous (IRR, 0.92, 95% CI, 0.87-0.97) and current use of combined (IRR, 0.93; 95% CI, 0.91-0.96) contraceptive were associated with a reduced risk of severe asthma exacerbation compared with non-use, as did longer duration of use (three to four years: IRR, 0.94; 95% CI, 0.92-0.97; five plus years: IRR, 0.91; 95% CI, 0.89-0.93). Progesterone-only contraceptives showed no association with reduced risk of severe exacerbation.

This is the largest longitudinal study investigating the effect of hormonal contraceptives on a key clinical outcome of asthma in reproductive-age women with already established asthma. However, it must be noted that this is an observational study and cannot establish a causative association.

Nwaru BI, Tibble H, Shah SA, Pillinger R, McLean S, Ryan DP, Critchley H, Price DB, Hawrylowicz CM, Simpson CR, Soyiri IN, Appiagyei F, Sheikh A. Hormonal contraception and the risk of severe asthma exacerbation: 17-year population-based cohort study. Thorax. 2020 Nov 23 [Epub ahead of print]. doi: 10.1136/ thoraxjnl-2020-215540 View full text

This article originally appeared on Univadis, part of the Medscape Professional Network.

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