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
Accepted on April 12, 2007
Gender Differences in Severe Pulmonary Emphysema
Fernando J Martinez1*, Jeffrey L Curtis1, Frank Sciurba2, Jeanette Mumford3, Nicholas D Giardino4, Gail Weinmann5, Ella Kazerooni6, Susan Murray3, Gerard J Criner7, Donald D Sin8, James Hogg8, Andrew L Ries9, MeiLan Han1, Alfred P Fishman10, Barry Make11, Eric A Hoffman12, Zab Mohsenifar13, and Robert Wise14
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
This article has been cited by other articles:
|
|
|
|
 
A. W. Sheel, J. A. Guenette, R. Yuan, L. Holy, J. R. Mayo, A. M. McWilliams, S. Lam, and H. O. Coxson
Evidence for dysanapsis using computed tomographic imaging of the airways in older ex-smokers
J Appl Physiol,
November 1, 2009;
107(5):
1622 - 1628.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. B. Grydeland, A. Dirksen, H. O. Coxson, S. G. Pillai, S. Sharma, G. E. Eide, A. Gulsvik, and P. S. Bakke
Quantitative computed tomography: emphysema and airway wall thickness by sex, age and smoking
Eur. Respir. J.,
October 1, 2009;
34(4):
858 - 865.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. G. Camp, D. E. O'Donnell, and D. S. Postma
Chronic Obstructive Pulmonary Disease in Men and Women: Myths and Reality
Proceedings of the ATS,
September 15, 2009;
6(6):
535 - 538.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. D. Maclay, D. A. McAllister, N. L. Mills, F. P. Paterson, C. A. Ludlam, E. M. Drost, D. E. Newby, and W. MacNee
Vascular Dysfunction in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med.,
September 15, 2009;
180(6):
513 - 520.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. S. Wan and E. K. Silverman
Genetics of COPD and Emphysema
Chest,
September 1, 2009;
136(3):
859 - 866.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. O. Coxson and S. Lam
Quantitative Assessment of the Airway Wall Using Computed Tomography and Optical Coherence Tomography
Proceedings of the ATS,
August 15, 2009;
6(5):
439 - 443.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. J. Kim, E. K. Silverman, E. Hoffman, G. J. Criner, Z. Mosenifar, F. C. Sciurba, B. J. Make, V. Carey, R. S. J. Estepar, A. Diaz, et al.
CT Metrics of Airway Disease and Emphysema in Severe COPD
Chest,
August 1, 2009;
136(2):
396 - 404.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. Sverzellati, E. Calabro, G. Randi, C. La Vecchia, A. Marchiano, J-M. Kuhnigk, M. Zompatori, P. Spagnolo, and U. Pastorino
Sex differences in emphysema phenotype in smokers without airflow obstruction
Eur. Respir. J.,
June 1, 2009;
33(6):
1320 - 1328.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. E. Robinson, B. C. Trapnell, M. L. Goris, L. M. Quittell, and D. N. Cornfield
Quantitative Analysis of Longitudinal Response to Aerosolized Granulocyte-Macrophage Colony-Stimulating Factor in Two Adolescents With Autoimmune Pulmonary Alveolar Proteinosis
Chest,
March 1, 2009;
135(3):
842 - 848.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Mair, J. J. Miller, D. McAllister, J. Maclay, M. Connell, J. T. Murchison, and W. MacNee
Computed tomographic emphysema distribution: relationship to clinical features in a cohort of smokers
Eur. Respir. J.,
March 1, 2009;
33(3):
536 - 542.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. P. de Torres, C. G. Cote, M. V. Lopez, C. Casanova, O. Diaz, J. M. Marin, V. Pinto-Plata, M. M. de Oca, H. Nekach, L. J. Dordelly, et al.
Sex differences in mortality in patients with COPD
Eur. Respir. J.,
March 1, 2009;
33(3):
528 - 535.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Togo, O. Holz, X. Liu, H. Sugiura, K. Kamio, X. Wang, S. Kawasaki, Y. Ahn, K. Fredriksson, C. M. Skold, et al.
Lung Fibroblast Repair Functions in Patients with Chronic Obstructive Pulmonary Disease Are Altered by Multiple Mechanisms
Am. J. Respir. Crit. Care Med.,
August 1, 2008;
178(3):
248 - 260.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. W. Voltz, J. W. Card, M. A. Carey, L. M. DeGraff, C. D. Ferguson, G. P. Flake, J. C. Bonner, K. S. Korach, and D. C. Zeldin
Male Sex Hormones Exacerbate Lung Function Impairment after Bleomycin-Induced Pulmonary Fibrosis
Am. J. Respir. Cell Mol. Biol.,
July 1, 2008;
39(1):
45 - 52.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. L. Wright, M. Cosio, and A. Churg
Animal models of chronic obstructive pulmonary disease
Am J Physiol Lung Cell Mol Physiol,
July 1, 2008;
295(1):
L1 - L15.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. A. Minai, J. Benditt, and F. J. Martinez
Natural History of Emphysema
Proceedings of the ATS,
May 1, 2008;
5(4):
468 - 474.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. MacNee
Update in Chronic Obstructive Pulmonary Disease 2007
Am. J. Respir. Crit. Care Med.,
April 15, 2008;
177(8):
820 - 829.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. D. Sin, S. B.-Z. Cohen, A. Day, H. Coxson, and P. D. Pare
Understanding the Biological Differences in Susceptibility to Chronic Obstructive Pulmonary Disease between Men and Women
Proceedings of the ATS,
December 1, 2007;
4(8):
671 - 674.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. J. Greaves and L. A. Richardson
Tobacco Use, Women, Gender, and Chronic Obstructive Pulmonary Disease: Are the Connections Being Adequately Made?
Proceedings of the ATS,
December 1, 2007;
4(8):
675 - 679.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. L. DeMeo
The Yin and Yang of COPD: Sex/Gender Differences in the National Emphysema Treatment Trial
Am. J. Respir. Crit. Care Med.,
August 1, 2007;
176(3):
222 - 223.
[Full Text]
[PDF]
|
|
|
Copyright © 2007 American Thoracic Society
|
|
|
