Krefting Research Centre, Institute of Medicine, University of Gothenburg, Goteborg, Sweden
Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden.
Thorax. 2021 Feb;76(2):109-115. doi: 10.1136/thoraxjnl-2020-215540. Epub 2020 Nov 23.
Longitudinal studies investigating impact of exogenous sex steroids on clinical outcomes of asthma in women are lacking. We investigated the association between use of hormonal contraceptives and risk of severe asthma exacerbation in reproductive-age women with asthma.
We used the Optimum Patient Care Research Database, a population-based, longitudinal, anonymised primary care database in the UK, to construct a 17-year (1 January 2000-31 December 2016) retrospective cohort of reproductive-age (16-45 years, n=83 084) women with asthma. Using Read codes, we defined use, subtypes and duration of use of hormonal contraceptives. Severe asthma exacerbation was defined according to recommendations of the European Respiratory Society/American Thoracic Society as asthma-related hospitalisation, accident and emergency department visits due to asthma and/or oral corticosteroid prescriptions. Analyses were done using multilevel mixed-effects Poisson regression with QR decomposition.
The 17-year follow-up resulted in 456 803 person-years of follow-up time. At baseline, 34% of women were using any hormonal contraceptives, 25% combined (oestrogen/progestogen) and 9% progestogen-only contraceptives. Previous (incidence rate ratio (IRR) 0.94, 95% CI 0.92 to 0.97) and current (IRR 0.96, 95% CI 0.94 to 0.98) use of any, previous (IRR 0.92, 95% CI 0.87 to 0.97) and current use of combined (IRR 0.93, 95% CI 0.91 to 0.96) and longer duration of use (3-4 years: IRR 0.94, 95% CI 0.92 to 0.97; 5+ years: IRR 0.91, 95% CI 0.89 to 0.93) of hormonal contraceptives, but not progestogen-only contraceptives, were associated with reduced risk of severe asthma exacerbation compared with non-use.
Use of hormonal contraceptives may reduce the risk of severe asthma exacerbation in reproductive-age women. Mechanistic studies investigating the biological basis for the influence of hormonal contraceptives on clinical outcomes of asthma in women are required.
European Union electronic Register of Post-Authorisation Studies (EUPAS22967).
缺乏关于外源性性激素对女性哮喘临床结局影响的纵向研究。我们研究了生殖期女性使用激素避孕药与严重哮喘恶化风险之间的关系。
我们使用 Optimum Patient Care Research Database，这是一个基于人群的、纵向的、匿名的英国初级保健数据库，构建了一个 17 年（2000 年 1 月 1 日至 2016 年 12 月 31 日）的生殖期（16-45 岁）哮喘女性回顾性队列（n=83084）。使用 Read 编码，我们定义了激素避孕药的使用、类型和使用持续时间。严重哮喘恶化按照欧洲呼吸学会/美国胸科学会的建议定义为哮喘相关住院、因哮喘而到急症室就诊和/或口服皮质类固醇处方。使用多层次混合效应泊松回归和 QR 分解进行分析。
17 年的随访共产生了 456803 人年的随访时间。基线时，34%的女性使用任何一种激素避孕药，25%使用联合（雌激素/孕激素）避孕药，9%使用单纯孕激素避孕药。既往（发生率比（IRR）0.94，95%CI 0.92 至 0.97）和当前（IRR 0.96，95%CI 0.94 至 0.98）使用任何一种、既往（IRR 0.92，95%CI 0.87 至 0.97）和当前使用联合（IRR 0.93，95%CI 0.91 至 0.96）和使用时间较长（3-4 年：IRR 0.94，95%CI 0.92 至 0.97；5 年以上：IRR 0.91，95%CI 0.89 至 0.93）的激素避孕药与严重哮喘恶化风险降低相关，而单纯孕激素避孕药则没有。
生殖期女性使用激素避孕药可能会降低严重哮喘恶化的风险。需要进行机制研究，以调查激素避孕药对女性哮喘临床结局影响的生物学基础。
欧盟药品上市后监测研究电子登记系统（EUPAS22967）。
