Sex Differences in Severe Pulmonary Emphysema

Martínez, Fernando J.; Curtis, Jeffrey L.; Sciurba, Frank C.; Mumford, Jeanette A.; Giardino, Nicholas D.; Weinmann, Gail G.; Kazerooni, Ella A.; Murray, Susan; Criner, Gerard J.; Sin, Donald; Hogg, James C.; Ries, Andrew L.; Han, MeiLan K.; Fishman, Alfred P.; Make, Barry J.; Hoffman, Eric A.; Mohsenifar, Zab; Wise, Robert A.

doi:10.1164/rccm.200606-828oc

Cited by 304 publications

(253 citation statements)

References 69 publications

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“…1). This is different from what is seen in severe COPD subjects, whose emphysema was less peripheral in females, because the radial distribution of emphysema may have a functional impact, it was suggested that such difference likely accounted for the lower diffusing capacity of the lung for carbon monoxide (DL,CO) observed in females [8]. Unfortunately, we could not explore such morphological-functional relationships as the DL,CO was not part of our lung screening project.…”

Section: Discussionmentioning

confidence: 75%

“…Our findings substantially mirror and extend those reported in patients with COPD. Thus, an analysis limited to severe emphysematous patients from the National Emphysema Trial [8], showed that emphysema in females, relative to males, was less extensive and characterised by smaller hole size, but less peripheral involvement on CT. Furthermore, DRANSFIELD et al [15] demonstrated that females had less severe emphysema at all stages of COPD.…”

Section: Discussionmentioning

confidence: 99%

“…Based on previous findings of COPD [8,15], we sought to corroborate the existence of sex differences in emphysema features even among smokers without airflow obstruction. In this retrospective analysis on a lung cancer screening population, we have explored how sex influences the emphysema phenotype by using an advanced tool for emphysema measurement in a large, prospectively studied cohort of smokers without clinical evidence of airflow obstruction.…”

mentioning

confidence: 99%

“…Furthermore, males and females seem to respond differently in type and localisation of lung damage due to tobacco exposure, suggesting that the nature of biological injury may differ between sexes [5]. In COPD, female smokers are more likely than males to exhibit small airway disease, whereas males are prone to develop a more severe emphysematous phenotype [6][7][8]. However, emphysema is highly variable in smokers and is not necessarily associated with COPD [9,10].…”

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confidence: 99%

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Sex differences in emphysema phenotype in smokers without airflow obstruction

Sverzellati

Calabrò

Randi

et al. 2009

European Respiratory Journal

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Data on sex differences in emphysema are limited to chronic obstructive pulmonary disease. We aimed to verify whether such differences also exist in smokers without airflow obstruction, weighting their influence on the relationship between emphysema and clinical features.We evaluated both clinical and multidetector computed tomography (MDCT) data of 1,011 heavy smokers recruited by a lung cancer screening project. MDCT scans were analysed with software allowing lobar quantification of emphysema features. For these measures, multiple regression models were applied to assess the effect of patients sex, after allowance for age, body mass index (BMI), smoking history, forced expiratory volume in 1 s (FEV1) and forced vital capacity.The final study cohort consisted of 957 smokers without airflow obstruction. Compared with males, females exhibited an emphysema phenotype less extensive in each pulmonary lobe, characterised by smaller emphysematous areas and less concentrated in the core of the lung. However, in females, the increase of emphysema with age was more pronounced and displayed a more significant relationship with FEV1% decline; conversely, in males there was a stronger association with the decrease in BMI.Males and females respond differently to the type and location of lung damage due to tobacco exposure. In smokers, sex influences the relationship between emphysema and clinical features.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Sex differences in emphysema phenotype in smokers without airflow obstruction

Sverzellati

Calabrò

Randi

et al. 2009

European Respiratory Journal

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“…Women are suggested to be more susceptible to the effects of tobacco smoke and therefore are at higher risk of developing COPD 10 . Some studies have found structural differences within the lungs, with men having more emphysema than women [11][12][13] while others have found that in women the walls of the small airways are thicker 13 .…”

Section: Background Chronic Obstructive Pulmonary Diseasementioning

confidence: 99%

The relationship between physical function and experience of fatigue in patients with chronic obstructive pulmonary disease

Tödt¹

2014

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Background Chronic Obstructive Pulmonary Disease (COPD) is increasing throughout the world and most rapidly among women. COPD is characterized by a progressive loss of physical functions. The reason for this is multi-factorial and include not only lung related deficiencies but also several systemic consequences and symptoms of which several are potential restrictors of physical function. The relationship between physical function and symptoms are not clear, especially not among women with COPD. Aim The overall aim of this thesis was to illuminate the relationship between two dimensions of physical function (physical activity and physical capacity) and experience of fatigue. The specific aims were to explore factors associated with low physical activity and to examine experience of fatigue and its relationship to physical capacity and disease severity in men and women with COPD. Methods A cross-sectional study was conducted including 121 patients (67 women) with stable COPD and mean age of 67 (+/-7) years. Physical activity was measured with the International Physical Activity Questionnaire short form. Physical capacity included assessment of lung function (dynamic spirometry), exercise capacity (the 6-minute walk distance [perceived dyspnoea and leg fatigue in connection to the test]) and muscle strength (the Timed Stands Test and grip strength). Fatigue was assessed with structured questions covering the frequency, duration and severity of fatigue the previous month and patients were categorized as those with no fatigue, moderate fatigue or severe fatigue. Data about other symptoms (dyspnoea, anxiety and depression), symptom burden (Memorial Symptom Assessment Scale), fat and fat free mass (bio-impedance analysis) and smoking history was collected. Results Forty-two percent of the patients reported a low physical activity level. A majority of the patients reported experience of fatigue the previous month, 52% moderate fatigue and 25% severe fatigue. Low physical activity was associated with severe fatigue, worse exercise capacity and a higher amount of smoking. There were no differences in experience of fatigue between men and women. Men with fatigue had worse physical capacity and disease severity compared to men without fatigue. Women with fatigue had comparable physical capacity and disease severity to women without fatigue except for a higher perceived leg fatigue after the exercise capacity test. Multiple logistic regression analysis showed that exercise capacity and disease severity were associated with fatigue in both men and women but in women, leg fatigue was also strongly associated with the presence of fatigue. Conclusions Severe fatigue, worse exercise capacity and a higher amount of smoking were independently associated with low PA. This result suggests that patients with severe fatigue might need specific strategies to become more physically active. Presence of fatigue was associated with exercise capacity and disease severity in both men and women. In addition, in women leg fatigue was strongly a...

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Recent advances in chronic obstructive pulmonary disease pathogenesis: from disease mechanisms to precision medicine

Brandsma

Berge

Hackett

et al. 2019

The Journal of Pathology

144

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Chronic obstructive pulmonary disease (COPD) is a devastating lung disease with a high personal and societal burden. Exposure to toxic particles and gases, including cigarette smoke, is the main risk factor for COPD. Together with smoking cessation, current treatment strategies of COPD aim to improve symptoms and prevent exacerbations, but there is no disease-modifying treatment. The biggest drawback of today's COPD treatment regimen is the 'one size fits all' pharmacological intervention, mainly based on disease severity and symptoms and not the individual's disease pathology. To halt the worrying increase in the burden of COPD, disease management needs to be advanced with a focus on personalized treatment. The main pathological feature of COPD includes a chronic and abnormal inflammatory response within the lungs, which results in airway and alveolar changes in the lung as reflected by (small) airways disease and emphysema. Here we discuss recent developments related to the abnormal inflammatory response, ECM and age-related changes, structural changes in the small airways and the role of sex-related differences, which are all relevant to explain the individual differences in the disease pathology of COPD and improve disease endotyping. Furthermore, we will discuss the most recent developments of new treatment strategies using biologicals to target specific pathological features or disease endotypes of COPD.

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Sex Differences in Severe Pulmonary Emphysema

Cited by 304 publications

References 69 publications

Sex differences in emphysema phenotype in smokers without airflow obstruction

Sex differences in emphysema phenotype in smokers without airflow obstruction

The relationship between physical function and experience of fatigue in patients with chronic obstructive pulmonary disease

Recent advances in chronic obstructive pulmonary disease pathogenesis: from disease mechanisms to precision medicine

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