SHOULD SUPPLEMENTAL ESTROGENS BE USED AS STEROID-SPARING AGENTS IN ASTHMATIC WOMEN

Objective: To determine if supplemental estrogens should be used as st eroid-sparing agents in asthmatic women. Design: Case series. Setting: Ambulatory care, community hospital. Patients: Volunteer sample of th ree steroid-dependent asthmatic women. Intervention: Addition of conju gated estrogens to existing asthma treatment. Main outcome measure: Ab ility to decrease oral steroid requirement. Results: The mean age of t he women was 55 +/- 11 years; two were former smokers (cases 1 and 2) and one was a nonsmoker (case 3). One woman (case 3) was premenopausal and noted worsening of her asthma before and during menses. The other two women (cases 1 and 2) were postmenopausal. All three had been sym ptomatic from their asthma for 13.2 +/- 17.6 years. Each woman was bei ng treated with maximal doses of inhaled albuterol, inhaled steroids, and therapeutic theophylline doses. Despite this aggressive management , all three women required daily supplemental steroids (mean dose, 26. 7 +/- 11.5 mg of prednisone). Case 3 was started on a regimen of noret hindrone/ethinyl estradiol 1/35, and cases 2 and 3 were begun on regim ens of daily conjugated estrogen, 0.625 mg. Over the next 12 to 24 wee ks, the conditions of all three women were symptomatically improved an d their steroid therapy was discontinued. In addition, steroid-associa ted side effects of hypertension, weight gain, osteoporosis, and easy bruising lessened. Conclusion: Although this new observation of the st eroid-sparing effect of estrogens remains preliminary, further study m ay help advance understanding of the mechanisms and treatment of asthm a in women.