Just breathe: a review of sex and gender in chronic lung disease

Somayaji, Ranjani; Chalmers, James D.

doi:10.1183/16000617.0111-2021

Cited by 47 publications

(32 citation statements)

References 217 publications

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“…It was notable that the majority of studies focused on people with COPD, despite the significant global burden of other respiratory diseases such as asthma, bronchiectasis and cystic fibrosis, where exercise intolerance and activity limitation are central features [1,2]. Despite the identification of sex-based differences across the spectrum of chronic airways disease (i.e., higher prevalence of asthma and bronchiectasis and rising incidence of COPD in females) [72], almost two-thirds of the study population were male. In the current era of personalised and precision medicine, a key focus for future research is therefore to quantify activity status using valid research grade objective assessment tools [73] and evaluate PA promotion strategies in more diverse and inclusive populations, with consideration for disease sub-type, severity, comorbid illness, age, sex and ethnicity.…”

Section: Discussionmentioning

confidence: 99%

Physical activity promotion interventions in chronic airways disease: a systematic review and meta-analysis

Reilly

Sails

Stavropoulos‐Kalinoglou

et al. 2023

Eur Respir Rev

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Physical inactivity is common in people with chronic airways disease (pwCAD) and associated with worse clinical outcomes and impaired quality of life. We conducted a systematic review and meta-analysis to characterise and evaluate the effectiveness of interventions promoting step-based physical activity (PA) in pwCAD. We searched for studies that included a form of PA promotion and step-count outcome measure. A random-effects model was used to determine the overall effect size using post-intervention values. 38 studies (n=32 COPD; n=5 asthma; n=1 bronchiectasis; study population: n=3777) were included. Overall, implementing a form of PA promotion resulted in a significant increase in step-count: median (IQR) 705 (183–1210) when compared with usual standard care: −64 (−597–229), standardised mean difference (SMD) 0.24 (95% CI: 0.12–0.36), p<0.01. To explore the impact of specific interventions, studies were stratified into subgroups: PA promotion+wearable activity monitor-based interventions (n=17) (SMD 0.37, p<0.01); PA promotion+step-count as an outcome measure (n=9) (SMD 0.18, p=0.09); technology-based interventions (n=12) (SMD 0.16, p=0.01). Interventions promoting PA, particularly those that incorporate wearable activity monitors, result in a significant and clinically meaningful improvement in daily step-count in pwCAD.

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Section: Discussionmentioning

confidence: 99%

Physical activity promotion interventions in chronic airways disease: a systematic review and meta-analysis

Reilly

Sails

Stavropoulos‐Kalinoglou

et al. 2023

Eur Respir Rev

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“…An important finding of our study was the association of female sex with lower lung function and higher likelihood of RSP and PRISm, despite accounting for sex-related physiological differences in lung volumes and gender-related confounders. There is growing evidence examining sex differences in CLD [ 27 , 28 ]. However, the burden, phenotype, and risk factors of CLD in female PWH, an understudied population in CLD research, remain unclear.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Immunological Markers of Pulmonary Impairment Among People With HIV in India

Baidya

Sangle

Marbaniang

et al. 2022

Open Forum Infectious Diseases

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Background Despite anti-retroviral therapy, chronic lung diseases remain an important source of morbidity and mortality in people with HIV (PWH). We sought to identify clinical and immunological markers of pulmonary impairment among PWH in India. Methods 210 adult PWH receiving antiretroviral therapy (ART) were prospectively evaluated for three years. Plasma concentrations of interleukin (IL)-6, IL-10, TNF-a, D-dimer, C-reactive protein, soluble (s)CD14 and sCD163 were measured at enrolment. We used multi-variable linear and logistic regression to measure the association of baseline and time-varying clinical and immunological variables with spirometry defined chronic obstructive pulmonary disease (COPD), restrictive spirometry pattern (RSP), preserved ratio impaired spirometry (PRISm), forced expiratory volume in 1st second (FEV1) and forced vital capacity (FVC) during the third year of follow-up. Results After adjusting confounders, females were 7 times more likely to have RSP (95%CI 2.81 to 17.62, p < 0.001) and 22 times more likely to have PRISm (95%CI 7.42 to 69.92, p < 0.001) compared to men. Higher IL-6 concentrations were associated with lower FEV1 z-scores (β=-0.14 per log-higher, 95%CI -0.29 to 0.008, p = 0.06) and higher odds of COPD (aOR = 2.66 per log-higher, 95%CI 1.16 to 6.09, p = 0.02). Higher D-dimer concentrations were associated with lower FVC z-scores (β=-0.40 per log-higher, 95%CI -0.78 to -0.01, p = 0.04). Conversely, higher IL-10 concentrations were associated with lower odds of PRISm (aOR = 0.76 per log-higher, 95%CI 0.59 to 0.99, p = 0.04). Conclusions Female sex, higher concentrations of IL-6 and D-dimer, and lower concentrations of IL-10 were associated with pulmonary impairment in adult PWH receiving ART in India.

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“…The research string was as follows: (sex[Title] OR gender [Title]) AND (asthma OR COPD), "(("sex"[Title] OR "gender"[Title]) AND ("asthma"[MeSH Terms] OR "asthma"[All Fields] OR "asthmas"[All Fields] OR "asthma s"[All Fields] OR ("pulmonary disease, chronic obstructive"[MeSH Terms] OR ("pulmonary"[All Fields] AND "disease"[All Fields] AND "chronic"[All Fields] AND "obstructive"[All Fields]) OR "chronic obstructive pulmonary disease"[All Fields] OR "copd"[All Fields]))) AND (clinicaltrial[Filter] OR observationalstudy [Filter] OR randomizedcontrolledtri al [Filter])". Citations of previous published reviews and commentaries were checked to select further pertinent studies, if any [6,7,[18][19][20][21][22]. Literature search results were uploaded to Eppi-Reviewer 4 (EPPI-Centre Software.…”

Section: Search Strategymentioning

confidence: 99%

Sex differences in adult asthma and COPD therapy: a systematic review

et al. 2022

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Background Although asthma is more prevalent in women and the prevalence of COPD is increasing in women, the current international recommendations for the management and prevention of asthma and COPD provide no sex-related indication for the treatment of these diseases. Therefore, we systematically reviewed the evidence across literature on the sex-related effectiveness of asthma and COPD therapy. Methods This systematic review has been registered in PROSPERO and performed according to PRISMA-P. The PICO framework was applied for the literature search strategy: "patient problem” included adult patients suffering from asthma or COPD, “Intervention” regarded the pharmacological treatments for asthma or COPD, “Comparison” was vs. baseline, active controls, or placebo, “Outcome” was any difference sex-related in the effectiveness of interventions. Results In asthma 44% of the evidence reported that men responded better than women to the therapy, whereas this percentage was 28% in COPD. ICS was generally less effective in women than in men to treat asthma, and consistent evidence suggests that in asthmatic patients ICS/LABA/LAMA combination may be equally effective in both men and women. Due to the inconsistent available evidence, it is not possible to identify specific treatments whose effectiveness is related to sex difference in COPD patients. Conclusions There is a strong need of investigating the sex-related impact of asthma and COPD treatments. Pre-specified analyses in men and women should be planned in future trial protocols, a necessary condition that should be requested also by the regulatory agencies to overcome the anachronistic “one-size-fits-all” approach to therapeutics associated with suboptimal outcomes for patients.

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Just breathe: a review of sex and gender in chronic lung disease

Cited by 47 publications

References 217 publications

Physical activity promotion interventions in chronic airways disease: a systematic review and meta-analysis

Physical activity promotion interventions in chronic airways disease: a systematic review and meta-analysis

Clinical and Immunological Markers of Pulmonary Impairment Among People With HIV in India

Sex differences in adult asthma and COPD therapy: a systematic review

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