Sex differences in the clinical presentation and management of airflow obstruction

Abstract

The aim of the present study was to explore differences in the clinical expression, clinical diagnoses and management of airway diseases in a primary-care setting.Patients aged o35 yrs who had ever smoked were enrolled when they presented for any reason to one of eight rural primary-care practices. Respiratory symptom questionnaires and spirometry were administered. In total, 1,034 patients had acceptable and reproducible spirometry, of whom 550 (53%) were males and 484 (47%) were females.Males smoked more than females (41.2 versus 29.2 pack-yrs) respectively, and were more likely to have a pre-bronchodilator forced expiratory volume in one second/forced vital capacity ,0.70 at 22.4 versus 11.8%, respectively. However, more females than males reported breathlessness (51.0 versus 42.8%, respectively), a prior diagnosis compatible with airflow obstruction and taking respiratory medications (23.4 versus 14.9%, respectively).In conclusion, the current results suggest that females are more likely than males to report breathlessness and be prescribed respiratory medications independent of differences in the severity of airflow obstruction.

Seasonality and determinants of moderate and severe COPD exacerbations in the TORCH study

“…In addition, we found that sex and MRC dyspnoea grade at study entry, and smoking status are risk factors. Females report more breathlessness for similar levels of airflow obstruction and are more likely to receive treatment for COPD than males [35,36]. They may, therefore, be more likely to be classified as having an exacerbation.…”

Reconsidering sex-based stereotypes of COPD

“…Female COPD patients report a higher level of dyspnoea for the same level of ventilatory impairment than men. 56,57 In the Confronting COPD International Survey, women were more likely to report severe dyspnoea than men (odds ratio (OR) 1.30, 1.10-1.54), with similar cough (OR 1.08, 0.92-1.27) and less sputum (OR 0.84, 0.72-0.98), despite significantly lower pack-years of smoking (mean (SD) 36 (29) vs. 46 (35) pack-years). 58 Women enrolled in the National Emphysema Treatment Trial (NETT) also experienced greater dyspnoea and lower quality of life than men matched for precent predicted FEV 1 , age, proportion of the lung affected by emphysema, and pack-years.…”

Mars and Venus in the GP's office

“…Despite this, they were more likely to receive smoking cessation advice than males, indicating these diagnostic and reporting biases can adversely affect management for both sexes. The findings by DALES et al [7] also suggest that females may sometimes be prescribed respiratory medication inappropriately, without a relationship to airway obstruction or a clear diagnostic ''label'', increasing the possibility of side-effects without definite efficacy. Conversely, males may receive medication less often for milder airway obstruction, with potential detrimental effect, although the consequences of this are less clear for COPD than asthma.…”

“…By contrast, DALES et al [7] reported the clinical presentation and historical features in ever-smokers in a primary care setting in Canada. Respiratory symptom questionnaires and spirometry were administered in 1,034 (53% males) patients attending their general practitioner for any reason, but who had smoked at least 20 packs of cigarettes in their life.…”

“…The EUROSCOP study identifies cross-sectional and longitudinal differences between males and females in symptom prevalence, response to smoking and treatment, and highlights the closer relationship of symptom changes to disease status in males than females. The study by DALES et al [7] suggests females are more likely than males to report breathlessness and to be prescribed respiratory medications, independent of differences in severity of airflow obstruction. Although there appear to be some contradictory findings in these studies, it must be remembered that the two populations are quite different, one being recruited primarily through mass media, workplace and public places and all having airway obstruction (FEV1/VC ,0.7), and the other being from a primary care setting but presenting for any reason and with only 17% having airway obstruction.…”