Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Asthma UK Centre for Applied Research, Centre for Medical Informatics, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom.
Asthma UK Centre for Applied Research, Centre for Medical Informatics, The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, United Kingdom.
J Allergy Clin Immunol. 2020 Aug;146(2):438-446. doi: 10.1016/j.jaci.2020.02.027. Epub 2020 Apr 15.
Despite well-described sex differences in asthma incidence, there remains uncertainty about the role of female sex hormones in the development of asthma.
We sought to investigate whether hormonal contraceptive use, its subtypes, and duration of use were associated with new-onset asthma in reproductive-age women.
Using the Optimum Patient Care Research Database, a UK national primary care database, we constructed an open cohort of 16- to 45-year-old women (N = 564,896) followed for up to 17 years (ie, January 1, 2000, to December 31, 2016). We fitted multilevel Cox regression models to analyze the data.
At baseline, 26% of women were using any hormonal contraceptives. During follow-up (3,597,146 person-years), 25,288 women developed asthma, an incidence rate of 7.0 (95% CI, 6.9-7.1) per 1000 person-years. Compared with nonuse, previous use of any hormonal contraceptives (hazard ratio [HR], 0.70; 95% CI, 0.68-0.72), combined (HR, 0.70; 95% CI, 0.68-0.72), and progestogen-only therapy (HR, 0.70; 95% CI, 0.67-0.74) was associated with reduced risk of new-onset asthma. For current use, the estimates were as follows: any (HR, 0.63; 95% CI, 0.61-0.65), combined (HR, 0.65; 95% CI, 0.62-0.67), and progestogen-only therapy (HR, 0.59; 95% CI, 0.56-0.62). Longer duration of use (1-2 years: HR, 0.83; 95% CI, 0.81-0.86; 3-4 years: HR, 0.64; 95% CI, 0.61-0.67; 5+ years: HR, 0.46; 95% CI, 0.44-0.49) was associated with a lower risk of asthma onset than nonuse.
Hormonal contraceptive use was associated with reduced risk of new-onset asthma in women of reproductive age. Mechanistic investigations to uncover the biological processes for these observations are required. Clinical trials investigating the safety and effectiveness of hormonal contraceptives for primary prevention of asthma will be helpful to confirm these results.
尽管哮喘发病率存在明显的性别差异，但女性性激素在哮喘发病中的作用仍存在不确定性。
我们旨在研究激素避孕的使用及其类型和使用时间与育龄妇女新发哮喘之间的关系。
我们利用英国国家初级保健数据库 Optimum Patient Care Research Database，构建了一个 16 至 45 岁女性的开放性队列（N=564896），随访时间长达 17 年（即 2000 年 1 月 1 日至 2016 年 12 月 31 日）。我们使用多水平 Cox 回归模型来分析数据。
基线时，26%的女性正在使用任何一种激素避孕药。在随访期间（3597146 人年），有 25288 名女性发生哮喘，发病率为每 1000 人年 7.0（95%可信区间，6.9-7.1）。与未使用者相比，以前使用任何一种激素避孕药（风险比[HR]，0.70；95%可信区间，0.68-0.72）、联合使用（HR，0.70；95%可信区间，0.68-0.72）和孕激素仅治疗（HR，0.70；95%可信区间，0.67-0.74）与新发哮喘风险降低相关。对于当前使用者，估计值如下：任何（HR，0.63；95%可信区间，0.61-0.65）、联合使用（HR，0.65；95%可信区间，0.62-0.67）和孕激素仅治疗（HR，0.59；95%可信区间，0.56-0.62）。使用时间更长（1-2 年：HR，0.83；95%可信区间，0.81-0.86；3-4 年：HR，0.64；95%可信区间，0.61-0.67；5 年以上：HR，0.46；95%可信区间，0.44-0.49）与非使用者相比，哮喘发病风险较低。
激素避孕与育龄妇女新发哮喘风险降低相关。需要进行机制研究以揭示这些观察结果的生物学过程。针对激素避孕药用于哮喘一级预防的安全性和有效性的临床试验将有助于证实这些结果。
