4.6 Article

Female reproductive history in relation to chronic obstructive pulmonary disease and lung function in UK biobank: a prospective populationbased cohort study

Journal

BMJ OPEN
Volume 9, Issue 10, Pages -

Publisher

BMJ PUBLISHING GROUP
DOI: 10.1136/bmjopen-2019-030318

Keywords

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Funding

  1. UK Medical Research Council [MC/UU/12013/5, MR/M009351/1]
  2. Research Council of Norway's Centres of Excellence scheme [262700]
  3. MRC [MR/M009351/1] Funding Source: UKRI

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Objectives Sex differences in respiratory physiology and predilection for developing chronic obstructive pulmonary disease ( COPD) have been documented, suggesting that female sex hormones may influence pathogenesis. We investigated whether aspects of female reproductive health might play a role in risk of COPD among women. Design Population-based prospective cohort study. Setting UK Biobank recruited across 22 centres in the UK between 2006 to 2010. Primary and secondary outcomes measures We examined a range of female reproductive health indicators in relation to risk of COPD-related hospitalisation/death (n=271 271) using Cox proportional hazards regression; and lung function (n=273 441) using linear regression. Results Parity >3 was associated with greater risk of COPD-related hospitalisation/death (adjusted HR 1.45; 95% CI: 1.16 to 1.82) and lower forced expiratory volume at 1 second/forced vital capacity ratio (FEV 1/FVC) (adjusted mean difference -0.06; 95% CI: -0.07 to 0.04). Any oral contraception use was associated with lower risk of COPD-related hospitalisation/death (adjusted HR 0.85; 95% CI: 0.74 to 0.97) and greater FEV 1/FVC (adjusted mean difference 0.01; 95% CI: 0.003 to 0.03). Late menarche (age >15) and early menopause (age <47) were also associated with greater risk of COPD-related hospitalisation/death (but not lung function), while endometriosis was associated with greater FEV 1/FVC (not COPD-related hospitalisation/death). Early menarche (age <12 years) was associated with lower FEV 1/FVC (but not COPD hospitalisation/death). Associations with polycystic ovary syndrome (PCOS) or ovarian cysts, any hormone replacement therapy (HRT) use, hysterectomy-alone and both hysterectomy and bilateral oophorectomy were in opposing directions for COPD-related hospitalisation/death (greater risk) and FEV 1/FVC (positive association). Conclusions Multiple female reproductive health indicators across the life course are associated with COPD-related hospitalisation/death and lung function. Further studies are necessary to understand the opposing associations of PCOS/ovarian cysts, HRT and hysterectomy with COPD and objective measures of airway obstruction.

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