Risk of asthma onset after natural and surgical menopause: Results from the French E3N cohort

Abstract

Background: The gender switch in asthma incidence around puberty has been put forward to suggest a role of sex hormones in asthma. However, there are limited and inconsistent findings on change in asthma incidence with menopause. We aimed to investigate the associations between menopause and asthma incidence, and interactions with overweight/obesity. Methods: Asthma incidence was assessed in 67,872 women free of asthma at baseline (aged 41-68 years) and regularly followed-up as a part of the French E3N cohort. Adjusted hazard-ratios (aHR) were derived from Cox models considering age as the timescale , menopausal status as a time-varying covariate and taking into account menopausal treatment. Results: During 843,243 person-years of follow-up, 1,205 new-onset asthma cases were identified. Compared to pre-menopause, surgical menopause was associated with an increased risk of asthma onset (aHR=1.33 [95%CI 1.01-1.75]) but no association was observed for natural menopause (aHR=1.05 [0.84-1.32]). In women with natural menopause, a further analysis separating the transition through menopause and the later post-menopausal period did not show any change in asthma incidence with menopause in the total sample and in normal-weight women. However, in overweight/obese women, peri-menopausal and post-menopausal women had an increased risk of developing asthma as compared to pre-menopausal women of the same age (aHR=1.

Obesity, Inflammation, and Severe Asthma: an Update

“…N = 9888 Cross-sectional OR adj 1.92 (95% CI 1.35–2.75, p < 0.01), 2.24 (95% CI 1.23–4.09, p < 0.01), 1.89 (95% CI 1.30–2.75, p < 0.01) and 1.53 (95% CI 1.15–2.03, p < 0.01) for asthma in women only and BMI 25–29.9 kg/m 2 , BMI ≥ 30 kg/m 2 , WC ≥ 90 cm and WHt ratio ≥ 0.5 respectively Santos et al [ 36 ] Brazil, age 18–45 years. N = 60,202 Cross-sectional OR adj 1.49 (95% CI 1.14–1.96) for asthma and obesity Matulonga-Diakiese et al [ 37 ] France, women without asthma at baseline, age 41–68 years. N = 67 872 Cohort study, outcome was development of asthma HR adj 1.91 (95% CI 1.00–3.66) and 2.08 (95%CI 1.07–4.06) for overweight/obese peri-menopausal and post-menopausal women respectively and asthma Adj adjusted, BMI body mass index, CI confidence interval, HR hazard ratio, OR odds ratio, PR prevalence ratio, SE standard error, WC waist circumference, WHt waist-to-height …”

“…The association between obesity and asthma has historically been considered uni-directional; people with severe asthma become less active and deconditioned, weight increases, and increased usage of oral corticosteroids (OCS) further aggravates the weight gain cycle. Whilst this cohort of patients undeniably exists, increasing evidence supports the causal link between raised BMI, asthma, and poor asthma control (Table 1 [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]). Cluster cohort studies show a now widely recognised female-predominant obese severe asthma phenotype [38][39][40], particularly affecting peri-and post-menopausal women [37].…”

“…Whilst this cohort of patients undeniably exists, increasing evidence supports the causal link between raised BMI, asthma, and poor asthma control (Table 1 [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]). Cluster cohort studies show a now widely recognised female-predominant obese severe asthma phenotype [38][39][40], particularly affecting peri-and post-menopausal women [37]. However, a large cross-sectional US study has shown higher levels of oestradiol (OR 0.43 for current asthma, 95% CI 0.23-0.78) and testosterone (OR 0.59 for current asthma, 95% CI 0.37-0.91) appearing to play a protective role in obese asthma [41•].…”

Occupational exposure to disinfectants and asthma incidence in U.S. nurses: A prospective cohort study

“…Clinical manifestations of airway diseases vary over the lifespan, with gender‐related patterns . In adulthood, asthma incidence rates are higher in women, but vary with age, partly in relation to hormonal factors . Late‐onset asthma has been described as a distinct asthma phenotype, associated with higher morbidity .…”

A high blood eosinophil count may be a risk factor for incident asthma in population at risk

“…Third, the findings apply to populations at risk but may not be generalizable to all healthy people or to children. In the study, "population at risk" is defined as a population with a high risk of asthma, such as an older population [35], a more overweight and obese population [36], and people with more asthma-like diseases (nasal polyps, pneumonia, bronchitis or chronic obstructive pulmonary disease) [37,38]. Compared with the population excluded from the Shandong multi-center health check-up longitudinal study for Health Management because of missing blood eosinophil counts, the population included in the study had a higher risk of asthma, as mentioned above.…”