Sex Differences Among Adults Presenting to the Emergency Department With Acute Asthma

Academic Emergency Medicine

et al. 2005

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...

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Cydulka

Rowe

Academic Emergency Medicine

et al. 2005

“…29,30 Possible explanations for the gender differences in asthma may be that women experience more symptoms at a given level of airway obstruction and thus are overtreated compared with men, 30 or that men tend to decline a recommended admission. 29 These explanations may also apply to COPD patients. In a Danish cohort of stable COPD patients, women were also more likely to be admitted after controlling for other factors.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Hospital Admission among Emergency Department Patients with Chronic Obstructive Pulmonary Disease Exacerbation

Tsai

Academic Emergency Medicine

Cydulka

et al. 2007

Objectives: To determine the patient factors associated with hospital admission among adults who present to the emergency department (ED) with acute exacerbations of chronic obstructive pulmonary disease (COPD) and to determine whether admissions were concordant with recommendations in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Methods:The authors performed a prospective multicenter cohort study involving 29 EDs in the United States and Canada. By using a standard protocol, consecutive ED patients with COPD exacerbation were interviewed, and their charts were reviewed. Predictors of admission were determined by multivariate logistic regression.Results: Of 384 patients, 233 (61%; 95% confidence interval = 56% to 66%) were admitted. Multivariate analysis showed that a higher likelihood of admission was associated with older age, female gender, more pack-years of smoking, recent use of inhaled corticosteroid, self-reported activity limitation in the past 24 hours, higher respiratory rate at ED presentation, and a concomitant diagnosis of pneumonia. Patients who reported the ED as their usual site for problem COPD care, or who had mixed COPD and asthma, were less likely to be admitted. The authors confirmed five of the seven testable indications for hospital admission in the GOLD guidelines.Conclusions: Several patient factors were independently associated with hospital admission among ED patients with COPD exacerbations. Overall, concordance with admission recommendations in the GOLD guidelines was high. The authors also identified a few novel predictors of admission (female gender, ED as the usual site for problem COPD care, mixed diagnosis of COPD and asthma, recent use of inhaled corticosteroid) that require replication in future studies. ACADEMIC EMERGENCY MEDICINE 2007; 14:6-15 ª 2007 by the Society for Academic Emergency MedicineKeywords: chronic obstructive pulmonary disease, exacerbation, admission, emergency department C hronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. COPD is the third most common cause of hospitalization in the United States, with an estimated 726,000 hospitalizations in 2000. 1 Chronic obstructive pulmonary disease exacerbation also accounts for approximately 1.5 million emergency department (ED) visits per year. 1 Despite the tremendous burden of hospital admissions and ED visits caused by COPD exacerbations, little is known regarding factors associated with hospital admission from the ED. Previous studies focused on risk factors for admission in stable COPD patients, 2,3 external factors (e.g., air pollution) and admission, 4 or prognostic factors for in-hospital mortality. [5][6][7] However, these studies did not address the decision making for admission among patients presenting to the ED

Sex differences among children 2–13 years of age presenting at the emergency department with acute asthma

Schatz

Emond

et al. 2004

Pediatric Pulmonology

Hospitalization rates for asthma have been reported to be higher in males than females in children under age 15, but it is not clear whether this disparity reflects gender differences in prevalence, severity, or treatment. We performed a prospective cohort study as part of the Emergency Medicine Network. Patients aged 2-13 years who presented to the emergency department (ED) with acute asthma underwent a structured interview in the ED and another by telephone 2 weeks later. Of 1,602 patients, 61% (95% CI, 59-64%) were boys. Girls were slightly older than boys, although no material differences existed in acute presentation, chronic asthma characteristics, ED treatment, or ED course. There was no difference in admission rates for boys or girls (20% vs. 22%; P = 0.48). This finding persisted when adjusting for other factors in a multivariate logistic regression model. No sex differences were observed for relapse or ongoing exacerbation on univariate or multivariate analysis. These data suggest that asthma is not inherently more severe in boys with asthma compared to girls, and that the increased rate of hospitalizations in boys under age 13 is due to differences in prevalence, not severity.