Sex differences in severe pulmonary emphysema.
BACKGROUND
Limited data on sex differences in advanced COPD are available.


OBJECTIVE
To compare male and female emphysema patients with severe disease.


METHODS
One thousand fifty-three patients (38.8% female) evaluated for lung volume reduction surgery as part of the National Emphysema Treatment Trial were analyzed.


RESULTS
Detailed clinical, physiological, and radiological assessment, including quantitation of emphysema severity and distribution from helical chest computed tomography, was completed. In a subgroup (n = 101), airway size and thickness was determined by histological analyses of resected tissue. Women were younger and exhibited a lower body mass index (BMI), shorter smoking history, less severe airflow obstruction, lower Dl(co) and arterial Po(2), higher arterial Pco(2), shorter six-minute walk distance, and lower maximal wattage during oxygen-supplemented cycle ergometry. For a given FEV(1)% predicted, age, number of pack-years, and proportion of emphysema, women experienced greater dyspnea, higher modified BODE, more depression, lower SF-36 mental component score, and lower quality of well-being. Overall emphysema was less severe in women, with the difference from men most evident in the outer peel of the lung. Females had thicker small airway walls relative to luminal perimeters.


CONCLUSIONS
In patients with severe COPD, women, relative to men, exhibit anatomically smaller airway lumens with disproportionately thicker airway walls, and emphysema that is less extensive and characterized by smaller hole size and less peripheral involvement.
Martinez
Fernando J
FJ
University of Michigan, Division of Pulmonary and Critical Care Medicine, Ann Arbor, Michigan 48109-0360, USA. Fmartine@umich.edu
Curtis
Jeffrey L
JL
Sciurba
Frank
F
Mumford
Jeanette
J
Giardino
Nicholas D
ND
Weinmann
Gail
G
Kazerooni
Ella
E
Murray
Susan
S
Criner
Gerard J
GJ
Sin
Donald D
DD
Hogg
James
J
Ries
Andrew L
AL
Han
MeiLan
M
Fishman
Alfred P
AP
Make
Barry
B
Hoffman
Eric A
EA
Mohsenifar
Zab
Z
Wise
Robert
R
D000368:Aged; D001980:Bronchi / Q000473:pathology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011656:Pulmonary Emphysema / Q000150:complications / Q000473:pathology / Q000503:physiopathology* / Q000523:psychology; D011788:Quality of Life; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D012737:Sex Factors