Call to action: improving primary care for women with COPD

Tsiligianni, Ioanna; Rodríguez, Miguel Román; Lisspers, Karin; LeeTan, Tze; Infantino, Antonio

doi:10.1038/s41533-017-0013-2

Cited by 30 publications

(37 citation statements)

References 46 publications

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“…In summary, more research in sex differences and its implications for therapy is obviously needed [35,36]. However, we speculate that the association of female sex with several treatments in 2014 and not in 2005 could be explained by a higher awareness among physicians of the increased COPD prevalence, mortality and symptom level in women [37]. …”

Section: Discussionmentioning

confidence: 99%

Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

Sundh

Åberg

Hasselgren

et al. 2017

European Clinical Respiratory Journal

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Introduction: The aim was to investigate how the pattern of pharmacological treatment in Swedish patients with chronic obstructive pulmonary disease (COPD) has changed over a decade, and to identify factors associated with treatment. Methods: Data on patient characteristics and pharmacological treatment were collected using questionnaires from two separate cohorts of randomly selected primary and secondary care patients with a doctor’s diagnosis of COPD in central Sweden, in 2005 (n = 1111) and 2014 (n = 1329). Cross-tabulations and chi-square tests were used to compare maintenance treatment in 2005 and 2014, and to investigate the distribution of treatment by the 2017 Global Initiative for Obstructive Lung Disease (GOLD) ABCD groups. Multinomial logistic regression was used to analyze associations with the major types of recommended treatments: bronchodilator therapy, combined long-acting beta-2-antagonists (LABA) + inhaled corticosteroids (ICS), and triple inhaled therapy. Results: The proportion of patients with no maintenance treatment, with only LABA + ICS, and with sole ICS statistically significantly decreased (36 vs. 31%, 16 vs. 12% and 5 vs. 2%, respectively), and the proportion with triple inhaled therapy statistically significantly increased (29 vs. 40%). In 2014, triple inhaled therapy was the most common treatment in all GOLD groups except group A. In 2014, previous frequent exacerbations [OR (95% CI) 2.34 (1.62 to 3.36)], worse COPD Assessment Test score [1.07 (1.05 to 1.09)], female sex [2.13 (1.56 to 2.91)], and access to a specific responsible doctor [1.95 (1.41 to 2.69)] were associated with triple inhaled therapy. Current smoking [0.40 (0.28 to 0.57)] and overweight [0.62 (0.41 to 0.93)] were inversely associated with triple inhaled therapy. Conclusions: Over the last decade, triple inhaled therapy has increased, and no maintenance treatment, ICS, or LABA + ICS has decreased. Triple inhaled therapy is the most common treatment and is associated with previous exacerbations, higher symptom level, female sex, and having a specific responsible doctor.

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Section: Discussionmentioning

confidence: 99%

Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

Sundh

Åberg

Hasselgren

et al. 2017

European Clinical Respiratory Journal

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“…Furthermore, mortality among women due to COPD is higher than from many of the most commonly recognized forms of cancer. 10 In a Swedish study, COPD mortality among women increased during 1999-2009, and life expectancy in the COPD population was 9.4 years lower for women (vs. 7.4 years lower in men) compared with that of the average Swedish population. 13 Several findings also suggested that health status and quality of life is more impaired in women than in men with COPD.…”

Section: Introductionmentioning

confidence: 97%

“…4,5 However, recent studies demonstrated that the prevalence of COPD is similar among men and women. [6][7][8][9][10][11] A study by Mamary et al 12 reported that men were more prone to have underdiagnosis of COPD than women. Furthermore, mortality among women due to COPD is higher than from many of the most commonly recognized forms of cancer.…”

Section: Introductionmentioning

confidence: 99%

Gender differences among Swedish COPD patients: results from the ARCTIC, a real-world retrospective cohort study

Lisspers

Larsson

Janson

et al. 2019

npj Prim. Care Respir. Med.

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The present study aimed to generate real-world evidence regarding gender differences among chronic obstructive pulmonary disease (COPD) patients, especially as regards the diagnosis and outcomes in order to identify areas for improvement and management and optimize the associated healthcare resource allocation. ARCTIC is a large, real-world, retrospective cohort study conducted in Swedish COPD patients and a matched reference population from 52 primary care centers in 2000-2014. The incidence of COPD, prevalence of asthma and other comorbidities, risk of exacerbations, mortality rate, COPD drug prescriptions, and healthcare resource utilization were analyzed. In total, 17,479 patients with COPD were included in the study. During the study period, COPD was more frequent among women (53.8%) and women with COPD experienced more exacerbations vs. men (6.66 vs. 4.66). However, the overall mortality rate was higher in men compared with women (45% vs. 38%), but no difference for mortality due to COPD was seen between genders over the study period. Women seemed to have a greater susceptibility to asthma, fractures, osteoporosis, rheumatoid arthritis, rhinitis, depression, and anxiety, but appeared less likely to have diabetes, kidney diseases, and cardiovascular diseases. Furthermore, women had a greater risk of COPD-related hospitalization and were likely to receive a significantly higher number of COPD drug prescriptions compared with men. These results support the need to reduce disease burden among women with COPD and highlight the role of healthcare professionals in primary care who should consider all these parameters in order to properly diagnose and treat women with COPD.

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“…The clinical course of inflammatory lung diseases is influenced by several factors including sex, hormones, and poor air quality (Doherty et al 2009;Liptzin et al 2015;Silva et al 2017). Sex differences in lung disease incidence, prevalence, and severity have been noted for years, as well as increased prevalence rates for asthma, chronic obstructive pulmonary disease (COPD), and other inflammatory diseases in women versus men (Fuseini and Newcomb 2017;Tsiligianni et al 2017;Center for Disease Control and Prevention, 2018;Shah and Newcomb 2018). The number of women diagnosed with asthma, bronchitis, emphysema, COPD, pneumonia, and lung cancer has significantly increased in the past decade at higher rates than for men, and the mortality associated with many of these conditions is also now higher for women than men (Martinez et al 2007;Aryal et al 2014;Jenkins et al 2017).…”

Section: Introductionmentioning

confidence: 99%

Modulation of the lung inflammatory response to ozone by the estrous cycle

et al. 2019

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Emerging evidence suggests that sex differences exist in the control of lung innate immunity; however, the specific roles of sex hormones in the inflammatory response, and the mechanisms involved are unclear. Here, we investigated whether fluctuations in circulating hormone levels occurring in the mouse estrous cycle could affect the inflammatory response to air pollution exposure. For this, we exposed female mice (C57 BL /6J, 8 weeks old) at different phases of the estrous cycle to 2 ppm of ozone or filtered air ( FA ) for 3 h. Following exposure, we collected lung tissue and bronchoalveolar lavage fluid ( BAL ), and performed lung function measurements to evaluate inflammatory responses and respiratory mechanics. We found a differential inflammatory response to ozone in females exposed in the luteal phase (metestrus, diestrus) versus the follicular phase (proestrus, estrus). Females exposed to ozone in the follicular phase had significantly higher expression of inflammatory genes, including Ccl2, Cxcl2, Ccl20, and Il6, compared to females exposed in the luteal phase ( P < 0.05), and displayed differential activation of regulatory pathways. Exposure to ozone in the follicular phase also resulted in higher BAL neutrophilia, lipocalin levels, and airway resistance than exposure in the luteal phase ( P < 0.05). Together, these results show that the effects of ozone exposure in the female lung are affected by the estrous cycle phase, and potentially hormonal status. Future studies investigating air pollution effects and inflammation in women should consider the menstrual cycle phase and/or circulating hormone levels.

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Call to action: improving primary care for women with COPD

Cited by 30 publications

References 46 publications

Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

Factors influencing pharmacological treatment in COPD: a comparison of 2005 and 2014

Gender differences among Swedish COPD patients: results from the ARCTIC, a real-world retrospective cohort study

Modulation of the lung inflammatory response to ozone by the estrous cycle

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