COPD Course and Comorbidities: Are There Gender Differences?

Abstract

The prevalence of chronic obstructive pulmonary disease (COPD) has increased more rapidly in women than in men during the past two decades. Clinical presentation, comorbidities and prognosis may differ between genders and may influence management decisions. The influence of gender on COPD expression has not been clearly explained to date. Thus, the aim of this study was to evaluate significant differences between women and men suffering from COPD, regarding clinical presentation, pulmonary function test results, comorbidities, and prognosis. We prospectively recruited 470 patients with stable COPD with a history of smoking (152 women, 318 men, mean age 65.5 ± 8.8 vs. 66.6 ± 9.4 years, respectively). Comorbidities and exacerbations were recorded. Spirometry, body plethysmography, carbon monoxide diffusing capacity and 6-min walk tests were performed. The BODE prognostic score was also calculated. We found that women smoked less in comparison to men (30.4 vs. 41.9 pack-years, p < 0.05), showed more exacerbations (2.5 vs. 1.7, p = 0.01), higher forced expiratory volume in 1 s (FEV1%predicted), and increased residual volume/total lung capacity (RV/%TLC), but they had the same intensity of dyspnea. Women showed fewer comorbidities, on average, per patient (5.4 vs. 6.4, p = 0.002), but had a higher prevalence of at least seven comorbidities per patient (48.7% of women vs. 33.0% of men, p < 0.05). Women also had a significantly worse prognosis (4.6 vs. 3.1 BODE score, p < 0.05) that correlated with the number of comorbidities (r = 0.33, p < 0.01). In conclusion, this study strongly supports the existence of different gender phenotypes in COPD, especially regarding exacerbations, comorbidities, and prognosis. The gender difference may indicate a need for a targeted assessment and management of COPD in women and men.

Chronic hypoxaemia and gender status modulate adiponectin plasmatic level and its multimer proportion in severe COPD patients: new endotypic presentation?

“…Indeed, we observed a gender divergence in TLC and RV, without any difference in BMI. The increase of TLC and RV %pv observed in women in our study was also found in other recent studies [60][61][62]. These data suggested that, for a given FEV1, women had a more pronounced air trapping or hyperinflation than men, while hyperinflation was quite limited in our study (mean TLC was 105%pv in women and 87%pv in men).…”

“…These data suggested that, for a given FEV1, women had a more pronounced air trapping or hyperinflation than men, while hyperinflation was quite limited in our study (mean TLC was 105%pv in women and 87%pv in men). These observations are consistent with Grabicki et al that showed that COPD women had more hyperinflation, air trapping and comorbidities, inducing a higher risk of mortality [61]. In addition, in women, this increased air trapping also led to the development of hypercapnia [63].…”

Relationship of Red Cell Index with the Severity of Chronic Obstructive Pulmonary Disease

“…Previous research has found that there were significant differences between male patients and female patients in terms of disease severity, comorbidities and prognosis. 42,43 Although COPD has always been considered as the disease of elderly men, the burden of COPD on female patients has gradually increased in recent years. We hope that there will be more studies on female COPD patients in the future.…”

No gender-related bias in COPD diagnosis and treatment in Sweden: a randomised, controlled, case-based trial

“…Female patients develop COPD at earlier ages with lower tobacco consumption in comparison to males [4], and their quality of life is more impaired [25]. Females have an increased susceptibility to COPD due to sex-related biological factors [26] and may have different responses to medical treatment, follow-ups, smoking cessation interventions and pulmonary rehabilitation programmes [27][28][29][30][31][32]. Women with COPD exacerbations are younger, smoke more actively and have less comorbidity [33].…”