title: Sex differences in severe pulmonary emphysema.
abstract: 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.
authors: University of Michigan, Division of Pulmonary and Critical Care Medicine, Ann Arbor, Michigan 48109-0360, USA. Fmartine@umich.edu
authors: Fernando J
authors: FJ
authors: Martinez
authors: Jeffrey L
authors: JL
authors: Curtis
authors: Frank
authors: F
authors: Sciurba
authors: Jeanette
authors: J
authors: Mumford
authors: Nicholas D
authors: ND
authors: Giardino
authors: Gail
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authors: Weinmann
authors: Ella
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authors: Kazerooni
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authors: Murray
authors: Gerard J
authors: GJ
authors: Criner
authors: Donald D
authors: DD
authors: Sin
authors: James
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authors: Hogg
authors: Andrew L
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authors: Ries
authors: MeiLan
authors: M
authors: Han
authors: Alfred P
authors: AP
authors: Fishman
authors: Barry
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authors: Make
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authors: EA
authors: Hoffman
authors: Zab
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authors: Mohsenifar
authors: Robert
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authors: Wise
mesh_terms: 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