Jenkins M A, Dharmage S C, Flander L B, Douglass J A, Ugoni A M, Carlin J B, Sawyer S M, Giles G G, Hopper J L
Department of Public Health, The University of Melbourne, Carlton, Vic. 3053, Australia.
Clin Exp Allergy. 2006 May;36(5):609-13. doi: 10.1111/j.1365-2222.2006.02475.x.
Asthma is more prevalent among males in childhood, but females report higher rates in adulthood. The reasons are unknown; although it has been hypothesized that hormonal factors may explain this sex-dependent risk of adult-onset asthma.
To determine whether a woman's reproductive history or use of oral contraceptives is associated with adult-onset asthma.
In 1991-1993, we surveyed 681 women aged 29-32 years randomly sampled from participants first surveyed at age 7 years by the 1968 Tasmanian Asthma Survey, a study of all children born in 1961 and attending school. Current asthma was defined as reporting asthma or wheezy breathing in the past 12 months.
In women who did not have asthma or wheezy breathing by age 7 years, 13% had current asthma. The risk of current asthma in these who were parous increased with the number of births (odds ratio (OR) 1.50 per birth, 95% confidence interval (CI) 1.01-2.23 P=0.04) while women with one birth were at a lower risk than nulliparous women (OR 0.46 95% CI 0.2-1.06, P=0.07). Independent of parity, the risk decreased by 7% (95% CI 0-13%) per year of oral contraceptive pill use in all women. In women who did have asthma or wheezy breathing by age 7 years, neither reproductive history nor oral contraceptive pill use predicted current asthma.
Our observation that parity and decreased oral contraceptive use predict asthma in women, is consistent with the hypothesis that the asthma that develops after childhood is in part a response to endogenous and exogenous female hormones. This may be due to alterations of cytokine responses by the pregnant state, triggering adult-onset asthma in women.
哮喘在儿童期男性中更为普遍，但成年女性报告的发病率更高。原因尚不清楚；尽管有人推测激素因素可能解释这种成年期哮喘的性别依赖性风险。
确定女性的生殖史或口服避孕药的使用是否与成年期哮喘有关。
1991 - 1993年，我们对681名年龄在29 - 32岁的女性进行了调查，这些女性是从1968年塔斯马尼亚哮喘调查中7岁时首次接受调查的参与者中随机抽取的，该调查研究了1961年出生并上学的所有儿童。当前哮喘定义为在过去12个月内报告有哮喘或喘息性呼吸。
在7岁时没有哮喘或喘息性呼吸的女性中，13%有当前哮喘。这些已生育女性中当前哮喘的风险随着生育次数的增加而增加（每生育一次优势比（OR）为1.50，95%置信区间（CI）为1.01 - 2.23，P = 0.04），而生育一次的女性风险低于未生育女性（OR 0.46，95% CI 0.2 - 1.06，P = 0.07）。在所有女性中，独立于生育状况，口服避孕药使用每增加一年，风险降低7%（95% CI 0 - 13%）。在7岁时确实有哮喘或喘息性呼吸的女性中，生殖史和口服避孕药的使用均不能预测当前哮喘。
我们观察到生育状况和口服避孕药使用减少可预测女性哮喘，这与童年后发生的哮喘部分是对内源性和外源性女性激素的反应这一假设一致。这可能是由于妊娠状态改变了细胞因子反应，从而引发女性成年期哮喘。
