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Coelingh Bennink HJT, van Gennip FAM, Gerrits MGF, Egberts JFM, Gemzell-Danielsson K, Kopp-Kallner H. Health benefits of combined oral contraceptives - a narrative review. EUR J CONTRACEP REPR 2024; 29:40-52. [PMID: 38426312 DOI: 10.1080/13625187.2024.2317295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE This review presents an update of the non-contraceptive health benefits of the combined oral contraceptive pill. METHODS We conducted a literature search for (review) articles that discussed the health benefits of combined oral contraceptives (COCs), in the period from 1980 to 2023. RESULTS We identified 21 subjective and/or objective health benefits of COCs related to (i) the reproductive tract, (ii) non-gynaecological benign disorders and (iii) malignancies. Reproductive tract benefits are related to menstrual bleeding(including anaemia and toxic shock syndrome), dysmenorrhoea, migraine, premenstrual syndrome (PMS), ovarian cysts, Polycystic Ovary Syndrome (PCOS), androgen related symptoms, ectopic pregnancy, hypoestrogenism, endometriosis and adenomyosis, uterine fibroids and pelvic inflammatory disease (PID). Non-gynaecological benefits are related to benign breast disease, osteoporosis, rheumatoid arthritis, multiple sclerosis, asthma and porphyria. Health benefits of COCs related to cancer are lower risks of endometrial cancer, ovarian cancer and colorectal cancer. CONCLUSIONS The use of combined oral contraceptives is accompanied with a range of health benefits, to be balanced against its side-effects and risks. Several health benefits of COCs are a reason for non-contraceptive COC prescription.
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Affiliation(s)
| | | | | | | | | | - Helena Kopp-Kallner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Khramova RN, Tush EV, Khramov AA, Ovsyannikov DY, Popov KS, Dolbin IV, Khaletskaya OV, Stroganov AB, Kubysheva NI, Eliseeva TI. Relationship of Nutritional Status and Spirometric Parameters in Children with Bronchial Asthma. Sovrem Tekhnologii Med 2021; 12:12-23. [PMID: 34795975 PMCID: PMC8596246 DOI: 10.17691/stm2020.12.3.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Indexed: 12/23/2022] Open
Abstract
The potential mechanisms of bronchial asthma (BA) negative modification under the influence of obesity are currently being actively studied. However, at present, the effect of nutritional status on bronchial obstruction in children with BA cannot be considered established. In this regard, the purpose of this work was to study the relationship of spirometric parameters reflecting bronchial patency with nutritional status in children with asthma.
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Affiliation(s)
- R N Khramova
- Medical Resident, Department of Hospital Pediatrics; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - E V Tush
- Associate Professor, Department of Hospital Pediatrics; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - A A Khramov
- Medical Resident, Department of Hospital Pediatrics; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - D Yu Ovsyannikov
- Professor, Head of the Department of Children's Diseases; Peoples' Friendship University of Russia, 6 Miklukho-Maklaya St., Moscow, 117198, Russia
| | - K S Popov
- Medical Resident, Department of Hospital Pediatrics; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - I V Dolbin
- Consultant; City Clinical Hospital No.38, 22 Chernyshevskogo St., Nizhny Novgorod, 603000, Russia
| | - O V Khaletskaya
- Professor, Head of the Department of Hospital Pediatrics; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - A B Stroganov
- Associate Professor, Department of Faculty Surgery and Transplantology; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - N I Kubysheva
- Senior Researcher, Research Laboratory "Clinical Linguistics"; Kazan Federal University, 18 Kremlyovskaya St., Kazan, Republic of Tatarstan, 420008, Russia
| | - T I Eliseeva
- Professor, Department of Hospital Pediatrics; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
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Nwaru BI, Sheikh A. Hormonal contraceptives and asthma in women of reproductive age: analysis of data from serial national Scottish Health Surveys. J R Soc Med 2015; 108:358-71. [PMID: 26152676 DOI: 10.1177/0141076815588320] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Sex steroid hormones may explain known gender-related variations in asthma prevalence and clinical manifestation. We investigated the relationship between use of hormonal contraceptives and asthma in women, and assessed evidence of biological interaction between use of hormonal contraceptives and body mass index in this relationship. DESIGN Population-based analysis using data from serial (i.e. 2003, 2008 and 2010) Scottish Health Surveys. SETTING Random samples of the Scottish general population. PARTICIPANTS A total of 3257 non-pregnant, 16-45-year-old women. EXPOSURE Current use of hormonal contraceptives. MAIN OUTCOME MEASURES Self-reported current physician-diagnosed asthma, current wheezing symptoms, wheezing attacks and treatment for asthma or wheeze. RESULTS Women comprising 30.9% (95% confidence interval 29.3-32.5) were currently using any hormonal contraceptive and current physician-diagnosed asthma was present in 6.5% (95% confidence interval 5.7-7.4). Use of any hormonal contraceptive was associated with reduced risk of current physician-diagnosed asthma (odds ratio 0.68; 95% confidence interval 0.47-0.98) and receiving ≥3 asthma care episodes (odds ratio 0.45; 95% confidence interval 0.25-0.82), but the evidence was equivocal for wheezing attacks. Use of hormonal contraceptives among overweight or obese women was non-statistically significantly associated with asthma, but there was 42-135% increased risk in overweight and obese non-contraceptive using women. CONCLUSIONS Use of hormonal contraceptives may reduce asthma exacerbations and number of care episodes. Overweight and obese non-contraceptive-using women may be at increased risk of asthma. Prospective studies are now needed to confirm these findings. Both oestrogen and progesterone may stimulate smooth airway muscle function and inhibit the activities of TH2 responses. Future studies should investigate these underlying mechanisms.
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Affiliation(s)
- Bright I Nwaru
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, EH8 9AG, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, EH8 9AG, UK Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA 02120, USA Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
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Wei J, Gerlich J, Genuneit J, Nowak D, Vogelberg C, von Mutius E, Radon K. Hormonal factors and incident asthma and allergic rhinitis during puberty in girls. Ann Allergy Asthma Immunol 2015; 115:21-27.e2. [PMID: 26003905 DOI: 10.1016/j.anai.2015.04.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 04/07/2015] [Accepted: 04/20/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Accumulating evidence is indicating that hormonal factors play a role in new-onset allergic rhinitis and asthma after puberty. OBJECTIVE To determine whether age at menarche and use of hormonal contraceptives predict new-onset allergic rhinitis and asthma after puberty in young German women. METHODS A prospective community-based cohort study followed 1,191 girls 9 to 11 years old to early adulthood (19-24 years old). Self-administrated questionnaires concerning age at menarche, use of hormonal contraceptives, and status and age at onset of physician-diagnosed allergic rhinitis and asthma were collected at 16 to 18 and 19 to 24 years of age. Logistic regression models were used to analyze the incidence of asthma and allergic rhinitis after puberty and pooled estimates were obtained from the final model. RESULTS Eleven percent of girls developed allergic rhinitis after menarche and 3% reported new-onset asthma. Late menarche (>13 years of age) was statistically significantly inversely related to allergic rhinitis (adjusted odds ratio [OR] 0.32, 95% confidence interval [CI] 0.14-0.74) but did not reach the level of statistical significance for asthma (OR 0.32, 95% CI 0.07-1.42). Use of hormonal contraceptives was inversely associated with new-onset allergic rhinitis (OR 0.14, 95% CI 0.08-0.23) and asthma (OR 0.27, 95% CI 0.12-0.58) after puberty. CONCLUSION This study shows that girls with late onset of menarche are less likely to develop allergic rhinitis after puberty compared with those who have menarche at an average age. These findings also suggest that, in addition to endogenous hormones, hormonal contraceptives play a role and might protect young women from allergies and asthma.
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Affiliation(s)
- Junxiang Wei
- Occupational and Environmental Epidemiology & Net Teaching Unit, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (LMU), Munich, Germany
| | - Jessica Gerlich
- Occupational and Environmental Epidemiology & Net Teaching Unit, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (LMU), Munich, Germany.
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Dennis Nowak
- Occupational and Environmental Epidemiology & Net Teaching Unit, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (LMU), Munich, Germany
| | - Christian Vogelberg
- Pediatric Department, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - Erika von Mutius
- Dr v Haunersches Kinderspital, University Hospital Munich (LMU), Munich, Germany
| | - Katja Radon
- Occupational and Environmental Epidemiology & Net Teaching Unit, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (LMU), Munich, Germany
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Wang R, Custovic A, Simpson A, Belgrave DC, Lowe LA, Murray CS. Differing associations of BMI and body fat with asthma and lung function in children. Pediatr Pulmonol 2014; 49:1049-57. [PMID: 24166845 PMCID: PMC4265846 DOI: 10.1002/ppul.22927] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 08/30/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Current evidence suggests that in children there is a significant, albeit weak, association between asthma and obesity. Studies generally use body mass index (BMI) in evaluating body adiposity, but there are limitations to its use. METHOD Children from a population-based study attending follow-up (age 11 years) were weighed, measured and had percent body (PBF) and truncal (PTF) fat assessed using bioelectrical impedance. They were skin prick tested and completed spirometry. Parents completed a validated respiratory questionnaire. Children were defined as normal or overweight according to BMI and PBF cut-offs. We tested the association between these adiposity markers with wheeze, asthma, atopy, and lung-function. RESULTS Six hundred forty-six children (339 male) completed follow-up. BMI z-score, PBF, and PTF were all positively associated with current wheeze (odds ratio [95% CI]: 1.27 [1.03, 1.57], P = 0.03; 1.05 [1.00, 1.09], P = 0.03; 1.04 [1.00, 1.08], P = 0.04, respectively). Similar trends were seen with asthma. However, when examining girls and boys separately, significant positive associations were found with PBF and PTF and asthma but only in girls (gender interaction P = 0.06 and 0.04, respectively). Associations between being overweight and wheezing and asthma were stronger when overweight was defined by PBF (P = 0.007, 0.03) than BMI (P > 0.05). Higher BMI was significantly associated with an increase in FEV(1) and FVC, but only in girls. Conversely, increasing body fat (PBF and PTF) was associated with reduced FEV(1) and FVC, but only in boys. No associations between adiposity and atopy were found. CONCLUSION All adiposity measures were associated with wheeze, asthma, and lung function. However, BMI and PBF did not have the same effects and girls and boys appear to be affected differently.
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Affiliation(s)
- Ran Wang
- Manchester Academic Health Science Centre, University of Manchester, University Hospital of South Manchester, NHS Foundation Trust, Manchester, UK
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6
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Hsu JT, Missmer SA, Young MC, Correia KF, Twarog FJ, Coughlin IB, Hornstein MD, Schneider LC. Prenatal food allergen exposures and odds of childhood peanut, tree nut, or sesame seed sensitization. Ann Allergy Asthma Immunol 2013; 111:391-6. [PMID: 24125147 DOI: 10.1016/j.anai.2013.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 07/05/2013] [Accepted: 07/11/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND The prevalence of peanut (PN) and tree nut (TN) allergy in children has tripled in the past decade. Prenatal exposures, including maternal diet and medications, may account for some of this increase. In the United States, progesterone for luteal support in assisted reproduction is commonly formulated in PN or sesame seed (SS) oil. OBJECTIVE To determine whether prenatal exposure to PN or SS oil as progesterone in oil increases the child's odds of PN, TN, or SS allergy. METHODS Parents of 1,272 children evaluated by allergists from May 2005 through October 2009 completed questionnaires on conception, prenatal exposures, dietary history, and allergic history, with review of the child's medical record and skin prick and specific IgE test results. Odds ratios and 95% confidence intervals were calculated using multivariable adjusted logistic regression models. RESULTS Children of mothers with a history of infertility, in vitro fertilization, or use of progesterone in oil did not have increased odds of PN, TN, and/or SS sensitization. Maternal consumption of TNs during first 2 trimesters was associated with 60% higher odds of having a PN/TN/SS-sensitized child (95% confidence interval 1.01-2.51), with similarly increased odds with maternal SS ingestion. Odds of PN/TN/SS sensitization were doubled in children with asthma or environmental allergies. CONCLUSION Neither maternal infertility nor exposure to PN or SS oils through progesterone support during assisted reproduction treatment was associated with increased odds of PN/TN/SS sensitization in the child. However, maternal ingestion of TNs and SS during pregnancy was associated with increased odds of PN/TN/SS sensitization in the child.
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Affiliation(s)
- Joyce T Hsu
- Allergy Program, Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
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7
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Gender differences in asthma development and remission during transition through puberty: the TRacking Adolescents' Individual Lives Survey (TRAILS) study. J Allergy Clin Immunol 2010; 126:498-504.e1-6. [PMID: 20816186 DOI: 10.1016/j.jaci.2010.06.018] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 06/17/2010] [Accepted: 06/21/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND During puberty, a gender shift in asthma prevalence occurs, with a preponderance of boys before puberty. The mechanisms underlying this gender shift are unclear. OBJECTIVES We assessed associations of pubertal stages and transition through puberty with (1) the prevalence, incidence, and remission of asthma in male and female subjects; (2) total IgE levels; and (3) peak expiratory flow (PEF) fall during a shuttle run test (SRT). METHODS In the TRacking Adolescents' Individual Lives Survey study (n = 2,230; 51% female subjects), associations between pubertal stages and the prevalence, incidence, and remission of asthma were tested by using logistic regression and generalized estimating equations at a mean age of 11.1 (SD, 0.6), 13.6 (SD, 0.5), and 16.3 (SD, 0.7) years. Multiple linear regression analyses were used to study log-transformed total IgE levels and PEF fall during a SRT dependent on early versus late pubertal stages at a mean age of 16.3 years. RESULTS The prevalence of asthma was similar in boys (7.7%) and girls (7.4%) at a mean age of 11.1 years. The prevalence of asthma was significantly higher in female (6.2%) than male (4.3%) subjects at 16.3 years of age. There were no significant associations between transition of pubertal stages and the presence of asthma, either cross-sectionally or longitudinally. Pubertal stages and log-transformed total IgE levels or PEF fall during a SRT at age 16.3 years were not correlated. CONCLUSIONS A shift in the prevalence of asthma occurs between 11.1 and 16.3 years, which is due to both an increased incidence and decreased remission of asthma in female compared with male subjects. Pubertal stages could not be proved to explain the gender shift in asthma prevalence.
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8
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McKenzie R, Burton MD, Royce SG, Tang MLK. Age and sex influences on airway hyperresponsiveness. J Asthma 2010; 47:651-4. [PMID: 20632782 DOI: 10.3109/02770901003692801] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The precise relationship between age and gender and their influence on airway reactivity has not been clearly defined. Previous studies of age and gender influences on airway reactivity have been confounded by environmental influences such as cigarette smoking. The objective of this study was to examine the effect of age and gender on airway reactivity in C57BL/6 mice housed under controlled conditions, independent of confounding environmental factors. METHODS Mice were separated into four experimental groups based on age and gender: males at 6 and 12 weeks of age and females at 6 and 12 weeks of age. Airway reactivity to inhaled methacholine was examined in each group. RESULTS Significant differences in methacholine-induced airway reactivity were observed between the sexes at both age groups. At 6 weeks of age, the males demonstrated a significantly increased airway reactivity to methacholine as compared to females (p <.001). Paradoxically, at 12 weeks of age, the males demonstrated a significantly lower response to methacholine as compared to females (p <.001). Hence the relationship between age and airway reactivity is markedly different in males as compared to females. Examination of intragender differences revealed that in female mice, airway reactivity increased significantly with age (p <.001). In contrast, males demonstrated a significant reduction in airway reactivity with age (p <.001). CONCLUSION These findings demonstrate important differences in airway reactivity related to age and gender that are observed independent of any environmental influences. Furthermore, these findings highlight the importance of careful age and sex matching in studies of airway reactivity.
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Affiliation(s)
- Ross McKenzie
- Department of Allergy and Immunology, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
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Melgert BN, Ray A, Hylkema MN, Timens W, Postma DS. Are there reasons why adult asthma is more common in females? Curr Allergy Asthma Rep 2007; 7:143-50. [PMID: 17437685 DOI: 10.1007/s11882-007-0012-4] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Many epidemiological studies suggest that women are at increased risk of developing adult-onset asthma and also suffer from more severe disease than men. These gender differences appear to be the product of biological sex differences as well as sociocultural and environmental differences. The biological sex differences include genetic, pulmonary, and immunological factors. There is compelling evidence that sex hormones are major determinants of at least these biological sex differences. This paper explores the current literature regarding effects of sex hormones on immune function, resident lung cells, and regulation of local processes in the lung to shed light on underlying mechanisms of gender differences in asthma. More research is needed to understand these mechanisms in order to improve treatment of women with asthma.
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Affiliation(s)
- Barbro N Melgert
- University of Pittsburgh Medical Center, Division of Pulmonary, Allergy, and Critical Care Medicine, NW 628 MUH, 3459 Fifth Avenue, Pittsburgh, PA 15213, USA.
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10
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Asthma management in women. J Nurse Pract 2006. [DOI: 10.1016/j.nurpra.2006.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Herrera-Trujillo M, Barraza-Villarreal A, Lazcano-Ponce E, Hernández B, Sanín LH, Romieu I. Current wheezing, puberty, and obesity among mexican adolescent females and young women. J Asthma 2005; 42:705-9. [PMID: 16266963 DOI: 10.1080/02770900500265306] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Studies suggest an association between obesity and asthma. This may be modified by the physiological changes of puberty. We aim to explore the relation between overweight and current asthma among Mexican adolescent females and young women and evaluate how puberty may modify this association. METHODS Adolescent females (n=6944) and young women aged 11-24 years provided data. Current asthma was defined as wheezing in the last 12 months and obesity by body mass index (BMI). Puberty was defined by age at menarche. The association of obesity and current wheezing was evaluated by using logistic regression adjusting for confounders. The impact of puberty was studied by using stratified analysis by age at menarche. RESULTS The prevalence of current wheezing was 16.2% (95% CI 15-17). Compared with girls of normal weight (BMI 15 to >or=85 percentile), obese girls (BMI>or=95 percentile) had an increased risk of current wheezing of 19% (OR=1.19; 95% CI 0.97-1.46). After stratifying by age at menarche, we observed that this increased risk was only present in girls with menarche at 11 years old or younger (1.31%; 95% CI 1.01-1.73). CONCLUSIONS The association between obesity and asthma seems to be greater among girls with early puberty, suggesting the role of female hormones.
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Affiliation(s)
- Mónica Herrera-Trujillo
- Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México, and Department of Public-Health Sciences, University of Toronto, Ontario, Canada
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Svanes C, Real FG, Gislason T, Jansson C, Jögi R, Norrman E, Nyström L, Torén K, Omenaas E. Association of asthma and hay fever with irregular menstruation. Thorax 2005; 60:445-50. [PMID: 15923242 PMCID: PMC1747439 DOI: 10.1136/thx.2004.032615] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is some evidence that asthmatic women are more likely to have abnormal sex hormone levels. A study was undertaken to determine whether asthma and allergy were associated with irregular menstruation in a general population, and the potential role of asthma medication for this association. METHODS A total of 8588 women (response rate 77%) participated in an 8 year follow up postal questionnaire study of participants of the ECRHS stage I in Denmark, Estonia, Iceland, Norway, and Sweden. Only non-pregnant women not taking exogenous sex hormones were included in the analyses (n = 6137). RESULTS Irregular menstruation was associated with asthma (OR 1.54 (95% CI 1.11 to 2.13)), asthma symptoms (OR 1.47 (95% CI 1.16 to 1.86)), hay fever (OR 1.29 (95% CI 1.05 to 1.57)), and asthma preceded by hay fever (OR 1.95 (95% CI 1.30 to 2.96)) among women aged 26-42 years. This was also observed in women not taking asthma medication (asthma symptoms: OR 1.44 (95% CI 1.09 to 1.91); hay fever: OR 1.27 (95% CI 1.03 to 1.58); wheeze preceded by hay fever: OR 1.76 (95% CI 1.18 to 2.64)). Irregular menstruation was associated with new onset asthma in younger women (OR 1.58 (95% CI 1.03 to 2.42)) but not in women aged 42-54 years (OR 0.62 (95% CI 0.32 to 1.18)). The results were consistent across centres. CONCLUSIONS Younger women with asthma and allergy were more likely to have irregular menstruation. This could not be attributed to current use of asthma medication. The association could possibly be explained by common underlying metabolic or developmental factors. The authors hypothesise that insulin resistance may play a role in asthma and allergy.
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Affiliation(s)
- C Svanes
- Institute of Medicine, University of Bergen, Norway.
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13
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Abstract
Controversy exists as to the role of female reproductive hormones in asthma and COPD and, specifically, the effect of hormone replacement therapy (HRT) on these disorders. The differential incidence of asthma over the menstrual life cycle suggests an effect of female reproductive hormones on asthma; less data are available for COPD. Estrogen and progesterone have protean effects at the cellular level, consistent with potentially harmful and beneficial effects in lung disease. Large epidemiologic studies show an increased risk of development of asthma with the use of HRT but no consistent effects on COPD. Clinical and epidemiologic studies of exacerbations are limited, but suggest either a harmful effect or no effect of HRT on exacerbations of asthma and COPD. HRT appears to increase the risk of development of asthma but is not associated with the loss of lung function characteristic of COPD. Because the development of asthma is rare in postmenopausal women, the absolute increase in risk among women without asthma is modest. Physicians may wish to avoid HRT therapy in patients with difficult to control asthma and COPD. Clinical decisions to start or continue HRT among women without asthma or COPD should be based on the effects of HRT on more common diseases such as cardiovascular disease, breast cancer and osteoporosis, non-vertebral fractures and colon cancer.
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Affiliation(s)
- R Graham Barr
- Division of General Medicine, Department of Medicine, College of Physicians and Surgeons of Columbia University, New York, New York 10032, USA.
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14
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Xu B, Pekkanen J, Husman T, Keski-Nisula L, Koskela P. Maternal sex hormones in early pregnancy and asthma among offspring: a case-control study. J Allergy Clin Immunol 2004; 112:1101-4. [PMID: 14657866 DOI: 10.1016/j.jaci.2003.09.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sex hormones may be associated with the risk of onset of asthma. OBJECTIVE To study the association between maternal sex hormone concentrations during early pregnancy and the risk of asthma among offspring. METHODS A case-control study of 129 asthmatic children and 125 control children 5 to 6 years of age. Maternal sera in early pregnancy were obtained from the Finnish Maternal Cohort serum bank. RESULTS The means of serum progesterone and estradiol and free estradiol in mothers of asthmatic and control children were 81.0 and 82.8 nmol/L (P =.60), 7.87 nmol/L and 7.65 nmol/L (P =.99), and 149.5 pmol/L and 148.0 pmol/L (P =.95), respectively. There were also no differences in the mean concentrations of maternal sex hormones according to the presence of allergic rhinitis or atopic eczema among the children. CONCLUSIONS The current results do not support an association between maternal sex hormone concentrations during early pregnancy and onset of allergic disease in early childhood.
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Affiliation(s)
- Baizhuang Xu
- Unit of Environmental Epidemiology, National Public Health Institute, Kuopio, Finland
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15
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Lange P, Parner J, Prescott E, Ulrik CS, Vestbo J. Exogenous female sex steroid hormones and risk of asthma and asthma-like symptoms: a cross sectional study of the general population. Thorax 2001. [DOI: 10.1136/thx.56.8.613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUNDRecent evidence suggests a role for hormonal factors in the aetiology of asthma.METHODSData from a large study of women selected from the general population were used to relate treatment with oral hormonal contraceptives (OCP) and postmenopausal hormone replacement therapy (HRT) to the following asthma indicators: self-reported asthma, wheezing, cough at exertion, and use of medication for asthma. The study sample comprised 1536 premenopausal and 3016 postmenopausal women who participated in the third round of the Copenhagen City Heart Study in 1991–4. A total of 377 women were taking OCP (24.5% of premenopausal women) and 458 were on HRT (15.2% of postmenopausal women).RESULTSIn premenopausal women 4.8% reported having asthma. The prevalence of self-reported asthma, wheeze, use of asthma medication, and cough at exertion was not significantly related to use of OCP. In postmenopausal women the prevalence of self-reported asthma was 6.2%. A weak but consistent association was observed between HRT and self-reported asthma (OR 1.42 (95% CI 0.95 to 2.12)), wheeze (OR 1.29 (95% CI 1.02 to 1.64)), cough at exertion (OR 1.34 (95% CI 1.01 to 1.77)), and use of asthma medication (OR 1.45 (95% CI 0.97 to 2.18)).CONCLUSIONSIn this study of the general population no relationship was found between the use of OCP and asthma. Although an association was observed between HRT and asthma and asthma-like symptoms, this was relatively weak and it is concluded that there is no necessity to change present prescription practice.
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Lange P, Parner J, Prescott E, Ulrik CS, Vestbo J. Exogenous female sex steroid hormones and risk of asthma and asthma-like symptoms: a cross sectional study of the general population. Thorax 2001; 56:613-6. [PMID: 11462063 PMCID: PMC1746111 DOI: 10.1136/thorax.56.8.613] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Recent evidence suggests a role for hormonal factors in the aetiology of asthma. METHODS Data from a large study of women selected from the general population were used to relate treatment with oral hormonal contraceptives (OCP) and postmenopausal hormone replacement therapy (HRT) to the following asthma indicators: self-reported asthma, wheezing, cough at exertion, and use of medication for asthma. The study sample comprised 1536 premenopausal and 3016 postmenopausal women who participated in the third round of the Copenhagen City Heart Study in 1991-4. A total of 377 women were taking OCP (24.5% of premenopausal women) and 458 were on HRT (15.2% of postmenopausal women). RESULTS In premenopausal women 4.8% reported having asthma. The prevalence of self-reported asthma, wheeze, use of asthma medication, and cough at exertion was not significantly related to use of OCP. In postmenopausal women the prevalence of self-reported asthma was 6.2%. A weak but consistent association was observed between HRT and self-reported asthma (OR 1.42 (95% CI 0.95 to 2.12)), wheeze (OR 1.29 (95% CI 1.02 to 1.64)), cough at exertion (OR 1.34 (95% CI 1.01 to 1.77)), and use of asthma medication (OR 1.45 (95% CI 0.97 to 2.18)). CONCLUSIONS In this study of the general population no relationship was found between the use of OCP and asthma. Although an association was observed between HRT and asthma and asthma-like symptoms, this was relatively weak and it is concluded that there is no necessity to change present prescription practice.
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Affiliation(s)
- P Lange
- Copenhagen City Heart Study, Bispebjerg University Hospital, DK-2400 Copenhagen NV, Denmark.
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Figueroa-Muñoz JI, Chinn S, Rona RJ. Association between obesity and asthma in 4-11 year old children in the UK. Thorax 2001; 56:133-7. [PMID: 11209102 PMCID: PMC1745999 DOI: 10.1136/thorax.56.2.133] [Citation(s) in RCA: 222] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is evidence of a positive association between asthma and obesity in adults and in children. We investigated, in a large sample of English and Scottish primary school children, whether there is a consistent association between fatness and asthma symptoms in Britain. METHODS A cross sectional analysis was made of 18 218 children aged 4-11 years who participated in the 1993 or 1994 surveys of the National Study of Health and Growth (NSHG). Children belonged either to English or Scottish representative samples, or an English inner city sample. Asthma attacks in the previous year, occasional wheeze, or persistent wheeze were the symptoms used in the analysis. Body mass index (BMI) and the sum of triceps and subscapular skinfolds converted to standard deviation scores (SDS) were used to assess levels of fatness. RESULTS A total of 14 908 children (81.8%) were included in the analysis. In the multiple logistic analysis BMI and asthma (asthma attacks or wheeze) were associated in the representative sample (OR for the comparison of the 10th and 90th centiles of BMI 1.28, 95% CI 1.11 to 1.48), but sum of skinfolds was unrelated to asthma symptoms in most analyses. The association between asthma and BMI was stronger in girls than in boys in the inner city sample, but less convincingly in the representative sample. CONCLUSIONS Levels of obesity are associated with asthma symptoms regardless of ethnicity. The association is more consistent for BMI than for sum of skinfolds, partly because obese children are more advanced in their maturation than other children. There is some evidence that, as in adults, the association is stronger in girls than in boys, but only in the multiethnic inner city sample.
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Affiliation(s)
- J I Figueroa-Muñoz
- Department of Public Health Sciences, King's College, 5th Floor, Capital House, 42 Weston Street, London SE1 3QD, UK.
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Ensom MH. Gender-based differences and menstrual cycle-related changes in specific diseases: implications for pharmacotherapy. Pharmacotherapy 2000; 20:523-39. [PMID: 10809339 DOI: 10.1592/phco.20.6.523.35161] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pharmacists should be aware of gender-based differences and menstrual cycle-related changes in six diseases: asthma, arthritis, migraine, diabetes, depression, and epilepsy. In general, women report symptoms of physical illness at higher rates, visit physicians more frequently, and make greater use of other health care services than men. Whereas reasons for these gender differences are not fully clear, a combination of biologic, physiologic, social, behavioral, psychologic, and cultural factors most likely contributes. A significant percentage of women with asthma, arthritis, migraine, diabetes, depression, or epilepsy experience worsening of their disease premenstrually. The mechanism is unknown, but is speculated to be multifactorial because of many endogenous and exogenous modulators and mediators of each disease. As part of general therapy for cycle-related exacerbations of any one of these disorders, patients should be encouraged to use a menstrual calendar to track signs and symptoms for two to three cycles; if cyclic trends are identified, the women should anticipate exacerbations and avoid triggering factors. Cyclic modulation with pharmacotherapy may be attempted. If unsuccessful, a trial of medical ovulation suppression with a gonadotropin-releasing hormone (GnRH) analog may be warranted. If that is successful, continuous therapy with a GnRH analog and steroid add-back therapy or less expensive alternatives may be effective. If pharmacotherapy is impractical, hysterectomy and bilateral oophorectomy with estrogen replacement therapy is a last resort. Gender differences and menstrual cycle-related changes are important areas for clinical and mechanistic research.
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Affiliation(s)
- M H Ensom
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
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