SUBCLINICAL WORSENING OF BRONCHIAL-ASTHMA DURING ESTROGEN REPLACEMENTTHERAPY IN ASTHMATIC POSTMENOPAUSAL WOMEN

Background: Changes in asthma activity, in part related to the female hormonal profile, have been observed during pre-menstrual periods and during pregnancy. Estrogen replacement therapy (ERT) is an accepted ro utine treatment for post-menopausal women. The effect of ERT on diseas e activity in post-menopausal asthmatic women has not been investigate d in the past and is the subject of the present study. Methods: Fiftee n post-menopausal women with mild to moderate asthma completed two 30- day periods in which they measured peak expiratory flow (PEF) at home and filled in a daily diary of asthma-related symptoms. The first moni toring period was pre-ERT and the second was during ERT, In addition s pirometry was performed on each woman three times, twice pre-ERT and o nce during ERT, Results: The average daily PEF decreased from 241 (57. 9, S.D.) 1/min pre-ERT to 226.7 (62.7) 1/min during ERT (P < 0.004). S ignificant differences between the two study periods were also found i n morning and evening PEF values. Diurnal variation, measured as the d ifference between morning and evening PEF values, decreased significan tly from 22.3 (26.7) 1/min pre-ERT to 17.5 (26.8) 1/min during ERT (P < 0.007). The average daily consumption of bronchodilator inhalers inc reased significantly from 3.7 puffs/day pre-ERT to 4.3 puffs/day durin g ERT (P < 0.006), Although the differences in spirometry between the two periods did not reach statistical significance, a trend towards a worsening of the obstructive disorder during ERT was observed; However , the general feeling of well-being of the asthmatics did not change d uring the two periods. Conclusions: During ERT a sub-clinical worsenin g of disease activity was found in postmenopausal women with mild to m oderate asthma. We also detected a decrease in diurnal variation. Our findings should be substantiated by additional studies.