Should supplemental estrogens be used as steroid-sparing agents in asthmatic women?

OBJECTIVE

To determine if supplemental estrogens should be used as steroid-sparing agents in asthmatic women.

DESIGN

Case series.

SETTING

Ambulatory care, community hospital.

PATIENTS

Volunteer sample of three steroid-dependent asthmatic women.

INTERVENTION

Addition of conjugated estrogens to existing asthma treatment.

MAIN OUTCOME MEASURE

Ability to decrease oral steroid requirement.

RESULTS

The mean age of the women was 55 +/- 11 years; two were former smokers (cases 1 and 2) and one was a nonsmoker (case 3). One women (case 3) was premenopausal and noted worsening of her asthma before and during menses. The other two women (cases 1 and 2) were postmenopausal. All three had been symptomatic from their asthma for 13.2 +/- 7.6 years. Each woman was being treated with maximal doses of inhaled albuterol, inhaled steroids, and therapeutic theophylline doses. Despite this aggressive management, all three women required daily supplemental steroids (mean dose, 26.7 +/- 11.5 mg of prednisone). Case 3 was started on a regimen of norethindrone/ethinyl estradiol 1/35, and cases 2 and 3 were begun on regimens of daily conjugated estrogen, 0.625 mg. Over the next 12 to 24 weeks, the conditions of all three women were symptomatically improved and their steroid therapy was discontinued. In addition, steroid-associated side effects of hypertension, weight gain, osteoporosis, and easy bruising lessened.

CONCLUSION

Although this new observation of the steroid-sparing effect of estrogens remains preliminary, further study may help advance understanding of the mechanisms and treatment of asthma in women.