Published ahead of print on April 12, 2007, doi:10.1164/rccm.200606-828OC Am. J. Respir. Crit. Care Med., Volume 176, Number 3, August 2007, 243-252 A more recent version of this article appeared on August 1, 2007
Submitted on June 21, 2006 Gender Differences in Severe Pulmonary EmphysemaFernando J Martinez1*,1 Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States, 2 Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA, 3 Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA, 4 Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA, 5 Division of Lung Diseases, National Heart, Lung and Blood Institute, Bethesda, MD, USA, 6 Department of Radiology, University of Michigan, Ann Arbor, MI, USA, 7 Division of Pulmonary and Critical Care Medicine, Temple University, Philadelphia, PA, USA, 8 Respiratory Department, University of British Columbia, Vancouver, BC, Canada, 9 Department of Medicine, University of California, San Diego, CA, USA, 10 Office of Program Development, University of Pennsylvania, Philadelphia, PA, USA, 11 Division of Pulmonary Sciences and Critical Care Medicine, National Jewish Medical and Research Center, Denver, CO, USA, 12 Department of Radiology, University of Iowa, Iowa City, IA, USA, 13 Division of Pulmonary Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA, 14 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA * To whom correspondence should be addressed. E-mail: fmartine{at}umich.edu.
Background: To address the limited data on gender differences in advanced COPD, we compared male and female emphysema patients evaluated for lung volume reduction surgery as part of the National Emphysema Treatment Trial. Methods: One thousand and fifty three patients (38.8 % female) underwent detailed clinical, physiological and radiological assessment, including quantitation of emphysema severity and distribution from helical chest CT. In a subgroup (n=101), airway size and thickness was determined by histological analyses of resected tissue. Results: Women were younger and exhibited a lower BMI, shorter smoking history, less severe airflow obstruction, lower DLCO 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. Conclusion: In this large, retrospectively studied cohort of severe COPD patients 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 These striking gender-specific differences demonstrate the clinical heterogeneity among patients with advanced emphysema, and emphasize the importance of increased research into COPD pathogenesis. Key words: Chronic obstructive pulmonary disease, women's health, emphysema, computed tomography, prognosis
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