title: Gender differences in emergency department patients with chronic obstructive pulmonary disease exacerbation.
abstract: OBJECTIVE
  Although more men are diagnosed as having chronic obstructive pulmonary disease (COPD), its prevalence is increasing among women. Little is known about gender differences in exacerbations of COPD. The objective of this study was to determine if acute presentation, management, and outcomes differ among men and women seeking care in the emergency department (ED) for exacerbation of COPD.
  
  
  METHODS
  This was a secondary analysis of a prospective cohort study of ED patients aged 55 years or older who presented with an exacerbation of COPD. Subjects underwent structured interviews in the ED and two weeks later.
  
  
  RESULTS
  The cohort consisted of 397 subjects with COPD, of whom 52% were women. Self-report of COPD only tended to be more common among men (61% of men vs. 52% of women), while mixed COPD/asthma tended to be more common among women (39% vs. 48%; p = 0.10). Despite reporting similar chronic symptom severity, women were less likely than men to use anticholinergic agents before their ED visit (59% vs. 69%; p = 0.04). During the exacerbation, women initiated less home therapy and were less likely to seek emergency care within the first 24 hours of symptom onset (25% vs. 36%; p = 0.01). Although ED care and disposition were similar, post-ED outcomes differed. At two-week follow-up, men were more likely to report an ongoing exacerbation (42% vs. 31%; p = 0.03).
  
  
  CONCLUSIONS
  Men and women who present to the ED for treatment of an exacerbation of COPD have substantial differences in long-term medication use, self-treatment during exacerbation, delay in emergency care, and post-ED outcomes. Further studies are warranted to confirm and explain these gender-related differences.
authors.affiliation: Department of Emergency Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA. rcydulka@metrohealth.org
authors.forename: Rita K
authors.initials: RK
authors.lastname: Cydulka
authors.forename: Brian H
authors.initials: BH
authors.lastname: Rowe
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.forename: Charles L
authors.initials: CL
authors.lastname: Emerman
authors.forename: Alfred R
authors.initials: AR
authors.lastname: Rimm
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000208:Acute Disease; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000368:Aged; D001249:Asthma / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000453:epidemiology*; D044469:Racial Groups / Q000706:statistics & numerical data; D017678:Sex Distribution; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000318:Adrenergic beta-Agonists; D018680:Cholinergic Antagonists