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Sex Differences in Severe Pulmonary Emphysema

¹ University of Michigan, Division of Pulmonary and Critical Care Medicine, Ann Arbor, Michigan; ² University of Pittsburgh, Division of Pulmonary and Critical Care Medicine, Pittsburgh, Pennsylvania, ³ University of Michigan School of Public Health, Department of Biostatistics, Ann Arbor, Michigan; ⁴ University of Michigan, Department of Psychiatry, Ann Arbor, Michigan; ⁵ National Heart, Lung and Blood Institute, Division of Lung Diseases, Bethesda, Maryland; ⁶ University of Michigan, Department of Radiology, Ann Arbor, Michigan; ⁷ Temple University, Division of Pulmonary and Critical Care Medicine, Philadelphia, Pennsylvania; ⁸ University of British Columbia, Respiratory Department, Vancouver, British Columbia, Canada; ⁹ University of California, Department of Medicine, San Diego, California; ¹⁰ University of Pennsylvania, Office of Program Development, Philadelphia, Pennsylvania; ¹¹ National Jewish Medical & Research Center, Division of Pulmonary Sciences and Critical Care Medicine, Denver, Colorado; ¹² University of Iowa, Department of Radiology, Iowa City, Iowa; ¹³ Cedars-Sinai Medical Center, Division of Pulmonary Medicine, Los Angeles, California; and ¹⁴ Johns Hopkins University, Division of Pulmonary and Critical Care Medicine, Baltimore, Maryland

Correspondence and requests for reprints should be addressed to Fernando J. Martinez, M.D., M.S., 1500 E. Medical Center Drive, 3916 Taubman Center, University of Michigan Health System, Ann Arbor, MI 48109-0360. E-mail: Fmartine{at}umich.edu

Rationale: Limited data on sex differences in advanced COPD are available.

Objectives: To compare male and female emphysema patients with severe disease.

Methods: One thousand fifty-three patients (38.8% female) evaluated for lung volume reduction surgery as part of the National Emphysema Treatment Trial were analyzed.

Measurements and Main Results: Detailed clinical, physiological, and radiological assessment, including quantitation of emphysema severity and distribution from helical chest computed tomography, was completed. In a subgroup (n = 101), airway size and thickness was determined by histological analyses of resected tissue. Women were younger and exhibited a lower body mass index (BMI), shorter smoking history, less severe airflow obstruction, lower DL_co and arterial PO₂, higher arterial PCO₂, shorter six-minute walk distance, and lower maximal wattage during oxygen-supplemented cycle ergometry. For a given FEV₁% predicted, age, number of pack-years, and proportion of emphysema, women experienced greater dyspnea, higher modified BODE, more depression, lower SF-36 mental component score, and lower quality of well-being. Overall emphysema was less severe in women, with the difference from men most evident in the outer peel of the lung. Females had thicker small airway walls relative to luminal perimeters.

Conclusions: In patients with severe COPD, women, relative to men, exhibit anatomically smaller airway lumens with disproportionately thicker airway walls, and emphysema that is less extensive and characterized by smaller hole size and less peripheral involvement.

Key Words: chronic obstructive pulmonary disease • emphysema • computed tomography • pulmonary function • gender

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Sex differences in chronic obstructive pulmonary disease are increasingly recognized. What This Study Adds to the Field In patients with severe COPD, women, relative to men, exhibit anatomically smaller airway lumens with disproportionately thicker airway walls, and emphysema that is less extensive and characterized by smaller hole size and less peripheral involvement.

 

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The Yin and Yang of COPD: Sex/Gender Differences in the National Emphysema Treatment Trial

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