What’s The Link Between Hormones and Asthma? An Expert Explains

Asthma is a common, chronic illness which involves the airways and results in airflow limitation which may be occasional, recurrent or persist for a long time if exposure to the initiating trigger continues. The affected individual feels breathless, may have cough, wheezing, and a feeling of tightness in the chest. 1 to 18% of world population is estimated to be affected by asthma.

Quite a bit has been discussed about triggers of asthma. However enough attention has not been paid to the relationship between hormones and asthma.

Here we shall discuss this relationship, and hope that this understanding and awareness would help in tracking the asthma symptoms throughout such periods of hormonal changes and to treat this serious and potentially life threatening condition.

Obesity

In childhood irrespective of the level of physical activity, obesity is associated with higher asthma prevalence. Severity and morbidity is higher in girls, but not in boys. In girls older than 11 years and women, asthma is five to seven times more common in obese people compared to those of normal weight. Further, it is more difficult to control asthma in obese children.

Sex Hormones

The effects of sex hormones on the symptomatology and progression of asthma are complex and may be associated with the fluctuation dynamics of the hormonal levels.

• Testosterone has immunosuppressive effects and is probably protective against immuno-inflammatory processes that trigger asthma.
• Oestrogen on the contrary, promotes bronchial hyper reactivity.
• Twenty to forty percent (20–40%) of premenopausal women suffer from pre- or peri-menstrual asthma (PMA) and experience an exacerbation or acute worsening in the week preceding menstruation. Probably this is due to Progesterone related increased inflammation in the bronchi.
• During pregnancy, asthma can change its manifestations.

Smoking and Hormones

Tobacco smoking is one of the most important triggers for bronchial asthma. Hormones result in another gender difference in relation to cigarette smoke. Women are more susceptible to cigarette smoke than men. Importantly, girls with asthma who begin to smoke develop physical tobacco dependency much faster than girls without asthma. These differences do not seem to exist in boys.

Puberty

Asthma can be significantly affected at the time of puberty. It becomes more common in incidence as well as severity in females

Menstruation

Asthma control can get affected according to the various time periods in the menstrual cycle.

• There is a rise followed by a drop in oestrogen levels during the ovulation period.
• Also, menstruation characterized by a drop in progesterone levels, can act as ‘trigger’ for asthmatic attacks in some people.
• Irregular menstrual cycle is also related with a poorly controlled asthma.

Medications

Medications taken for say pain during menstrual cycle, like aspirin and non-steroidal anti-inflammatory tablets (NSAID) such as such as ibuprofen, may trigger an asthma attack. However, paracetamol is safe. Contraceptive medications can either improve or worsen asthma symptoms.

HRT (Hormonal Replacement Therapy), especially oestrogen-only, medication can likewise be linked to an increased risk of developing asthma, as well as a worsening of asthma symptoms, in menopausal women.

Exercise Induced Asthma

Exercise induced asthma can either start or worsen after hormone containing medications. So one needs to be aware of this and inform the doctor in case symptoms develop or change after such treatment is started.

(Dr Neetu Talwar, Senior Consultant – Paediatric Pulmonology at Fortis Memorial Research Institute, Gurugram)