title: Gender associated differences in determinants of quality of life in patients with COPD: a case series study.
abstract: BACKGROUND
  The influence of gender on the expression of COPD has received limited attention. Quality of Life (QoL) has become an important outcome in COPD patients. The aim of our study was to explore factors contributing to gender differences in Quality of Life of COPD patients.
  
  
  METHODS
  In 146 men and women with COPD from a pulmonary clinic we measured: Saint George's Respiratory Questionnaire (SGRQ), age, smoking history, PaO2, PaCO2, FEV1, FVC, IC/TLC, FRC, body mass index (BMI), 6 minute walk distance (6MWD), dyspnea (modified MRC), degree of comorbidity (Charlson index) and exacerbations in the previous year. We explored differences between genders using Mann-Whitney U-rank test. To investigate the main determinants of QoL, a multiple lineal regression analysis was performed using backward Wald's criteria, with those variables that significantly correlated with SGRQ total scores.
  
  
  RESULTS
  Compared with men, women had worse scores in all domains of the SGRQ (total 38 vs 26, p = 0.01, symptoms 48 vs 39, p = 0.03, activity 53 vs 37, p = 0.02, impact 28 vs 15, p = 0.01). SGRQ total scores correlated in men with: FEV1% (-0.378, p < 0.001), IC/TLC (-0.368, p = 0.002), PaO2 (-0.379, p = 0.001), PaCO2 (0.256, p = 0.05), 6MWD (-0.327, p = 0.005), exacerbations (0.366, p = 0.001), Charlson index (0.380, p = 0.001) and MMRC (0.654, p < 0.001). In women, the scores correlated only with FEV1% (-0.293, p = 0.013) PaO2 (-0.315, p = 0.007), exacerbations (0.290, p = 0.013) and MMRC (0.628, p < 0.001). Regression analysis (B, 95% CI) showed that exercise capacity (0.05, 0.02 to 0.09), dyspnea (17.6, 13.4 to 21.8), IC/TLC (-51.1, -98.9 to -3.2) and comorbidity (1.7, 0.84 to 2.53) for men and dyspnea (9.7, 7.3 to 12.4) and oxygenation (-0.3, -0.6 to -0.01) for women manifested the highest independent associations with SGRQ scores.
  
  
  CONCLUSIONS
  In moderate to severe COPD patients attending a pulmonary clinic, there are gender differences in health status scores. In turn, the clinical and physiological variables independently associated with those scores differed in men and women. Attention should be paid to the determinants of QoL scores in women with COPD.
authors.affiliation: Respiratory Research Unit, Hospital Nuestra Sra de Candelaria, Tenerife, Spain. jupa65@hotmail.com
authors.forename: Juan P
authors.initials: JP
authors.lastname: de Torres
authors.forename: Ciro
authors.initials: C
authors.lastname: Casanova
authors.forename: Concepción
authors.initials: C
authors.lastname: Hernández
authors.forename: Juan
authors.initials: J
authors.lastname: Abreu
authors.forename: Angela
authors.initials: A
authors.lastname: Montejo de Garcini
authors.forename: Armando
authors.initials: A
authors.lastname: Aguirre-Jaime
authors.forename: Bartolome R
authors.initials: BR
authors.lastname: Celli
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D012737:Sex Factors; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D016387:Women's Health