Gender Differences in Emergency Department Patients with Chronic Obstructive Pulmonary Disease Exacerbation

Abstract

Objectives: 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 ¼ 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 ¼ 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 ¼ 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 ¼ 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. Chronic obstructive pulmonary disease (COPD) affects approximately 3%-14% of older adults, including 13%-35% of older smokers. [1][2][3] In the United States, COPD is the fourth most common cause of death, the third most common cause of hospitalization, and the only leading cause of death that is increasing. 4,5 Although COPD is more common among men, its prevalence is rapidly increasing among women. 3Numerous studies have reported both long-term physiologic and quality-of-life differences between men and women with COPD 6-8 ; however, none have focused on gender-related differences during treatment of exacerbations requiring emergency intervention. Recent literature suggests that such differences are commonly encountered during acute presentation of other disease processes, such as heart disease and asthma. [8][9][10][11][12][13][14][15][16][17][18] An understanding of this issue in patients with COPD is crucial because patients older than 55 years are a rapidly increasing proportion of the population; they account for 40% of emergency department (ED) visits and 57% of dollars spent on emergency care and subsequent hospitalization in this country. 19The purpose of this prospective, multicenter analysis was to identify gender differences among adults presenting to the ED with an exacerbation of COPD. METHODSStudy Design. This st...

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