In the first study to directly compare men and women with chronic obstructive pulmonary disease, or COPD, and severe emphysema, researchers have found that there are marked differences between the sexes.
The study, led by Fernando J. Martinez, M.D., of the University of Michigan, was reported in the August 1, 2007 issue of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
The investigators analyzed 1053 randomized patients--38.8 percent of whom were female--from 17 National Emphysema Treatment Trial (NETT) clinics. Patients were selected for severe chronic airflow obstruction and an emphysematous phenotype. They then compared symptomatic, physiological, radiological and histological data between men and women.
"From a public health perspective, the investigation of sex and gender differences in COPD in timely, because in 2000, the number of women with COPD surpassed the number of men," noted Dawn L. DeMeo, M.D., M.P.H., of Brigham and Young Women's Hospital in the accompanying editorial.
Women in the study had shorter smoking histories and lower body mass index than men, and experienced more breathlessness, lower lung function and decreased exercise capacity compared to men. They also reported more depression, a lower quality of well-being and scored more poorly on a test for overall mental health.
Radiological assessment showed that women had less extensive emphysema than men, with smaller emphysematous lesions. Histological analysis of lung tissue in 101 patients showed that women airways with thicker walls, and disproportionately reduced airway lumens in comparison to men.
However, even after controlling for age, FEV1% predicted (a standard measure of lung function), smoking history and severity of emphysema, the researchers found that women reported more breathlessness, higher depression, lower mental health and lower overall quality of life than men.
"These data showing greater breathlessness in women relative to men at similar degrees of airflow obstruction and emphysema severity imply that sex-specific anatomic differences must be considered in models of COPD pathogenesis," the researchers wrote.