Hormone replacement therapy and asthma onset in menopausal women: National cohort study

Syed A Shah* (Corresponding Author), Holly Tibble, Rebecca Pillinger, Susannah McLean, Dermot Ryan, Hilary Critchley, David Price, Catherine M Hawrylowicz, Colin R Simpson, Ireneous N Soyiri, Francis Appiagyei, Aziz Sheikh, Bright I Nwaru

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


BACKGROUND: There is uncertainty about the role of hormonal replacement therapy (HRT) in the development of asthma.

OBJECTIVE: We investigated whether use of HRT and duration of use was associated with risk of development of asthma in perimenopausal and postmenopausal women.

METHODS: We constructed a 17-year (from January 1, 2000, to December 31, 2016) open cohort of 353,173 women (aged 46-70 years) from the Optimum Patient Care Database, a longitudinal primary care database from across the United Kingdom. HRT use, subtypes, and duration of use; confounding variables; and asthma onset were defined by using the Read Clinical Classification System. We fitted multilevel Cox regression models to estimate hazard ratios (HRs) with 95% CIs.

RESULTS: During the 17-year follow-up (1,340,423 person years), 7,614 new asthma cases occurred, giving an incidence rate of 5.7 (95% CI = 5.5-5.8) per 1,000 person years. Compared with nonuse of HRT, previous use of any (HR = 0.83; 95% CI = 0.76-0.88), estrogen-only (HR = 0.89; 95% CI = 0.84-0.95), or combined estrogen and progestogen (HR = 0.82; 95% CI = 0.76-0.88) HRT was associated with a reduced risk of asthma onset. This was also the case with current use of any (HR = 0.79; 95% CI = 0.74-0.85), estrogen-only (HR = 0.80; 95% CI = 0.73-0.87), and combined estrogen and progestogen (HR = 0.78; 95% CI = 0.70-0.87) HRT. Longer duration of HRT use (1-2 years [HR = 0.93; 95% CI = 0.87-0.99]; 3-4 years [HR = 0.77; 95% CI = 0.70-0.84]; and ≥5 years [HR = 0.71; 95% CI = 0.64-0.78]) was associated with a dose-response reduced risk of asthma onset.

CONCLUSION: We found that HRT was associated with a reduced risk of development of late onset asthma in menopausal women. Further cohort studies are needed to confirm these findings.

Original languageEnglish
Pages (from-to)1662-1670
Number of pages9
JournalJournal of Allergy and Clinical Immunology
Issue number5
Early online date3 Dec 2020
Publication statusPublished - 31 May 2021


  • Asthma
  • estrogens
  • epidemiology
  • estradiol
  • progestogen


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