Hormone replacement therapy, body mass index, and asthma in peri-menopausal women: a cross-sectional survey

Francisco Gómez Real ^1*, Cecilie Svanes ², Eythor H Björnsson ³, Karl A Franklin ⁴, David Gislason ³, Thorarinn Gislason ³, Amund Gulsvik ⁵, Christer Janson ⁶, Rain Jogi ⁷, Torvid Kiserud ⁸, Dan Norbäck ⁶, Lennarth Nyström ⁹, Kjell Toren ¹⁰, Tore Wentzel-Larsen ⁸ and Ernst R Omenaas ¹¹

¹ Haukeland University Hospital, Bergen, Norway
² Haukeland Hospital, Norway
³ Landspitali University Hospital, Iceland
⁴ Department of Respiratory Medicine, Umeå University, Sweden
⁵ Dept of Thoracic Medicine, Institute of Medicine, University of Bergen, Norway
⁶ Uppsala University, Sweden
⁷ Tartu University Clinics, Estonia
⁸ Institute of Clinical Medicine, University of Bergen, Norway
⁹ Department of Public Health, Umeå University, Sweden
¹⁰ Sahlgrenska University Hospital, Sweden
¹¹ Haukeland University Hospital, Norway

^* To whom correspondence should be addressed. E-mail: francisco.real{at}med.uib.no.

Accepted 13 October 2005

Abstract

Background: Hormone replacement therapy (HRT) and obesity both appear to increase asthma risk. We wanted to investigate the association of HRT with asthma and hay fever in a population of peri-menopausal women, focusing on possible interaction with body mass index (BMI).

Methods: A postal questionnaire was sent to population-based samples in Denmark, Estonia, Iceland, Norway and Sweden in 1999-2001, and 8588 women aged 25-54 years responded (77%). Pregnant women, women using oral contraceptives, and women <46 years were excluded. Analyses included 2206 women aged 46-54 of which 884 were menopausal and 540 used HRT. Stratified analyses by BMI in tertiles were performed.

Results: HRT was associated with increased risk for asthma (OR=1.57[95% CI=1.07-2.30]), wheeze (OR=1.60[1.22-2.10]) and hay fever (OR=1.48[1.15-1.90]). The associations with asthma and wheeze were significantly stronger among women with BMI in the lower tertile (asthma OR=2.41[1.21-4.77]; wheeze OR=2.04[1.23-3.36]) as compared with heavier women (asthma: pinteraction= 0.030; wheeze: pinteraction=0.042). Increasing BMI was associated with more asthma (OR=1.08 [1.05-1.12] per kg/m2). This effect was only found in women not taking HRT (OR=1.10 [1.05-1.14] per kg/m2), while no such association could be detected in women taking HRT (OR=1.00 [0.92-1.08] per kg/m2) (pinteraction=0.046). Menopause was not significantly associated with asthma, wheeze or hay fever.

Conclusions: In peri-menopausal women there was an interaction between HRT and BMI in effects on asthma. HRT-users among lean women had as high a risk for asthma as overweight women not taking HRT. The authors suggest that HRT and overweight increase asthma risk through partly common pathways.

Keywords: ECRHS, HRT, RHINE, asthma, body mass index

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