Female COPD Patients Research Articles

Chest CT Airway and Vascular Measurements in Females with COPD or Long-COVID

Chest CT provides a way to quantify pulmonary airway and vascular tree measurements. In patients with COPD, CT airway measurement differences in females are concomitant with worse quality-of-life and other outcomes. CT total airway count (TAC), airway lumen area (LA), and wall thickness (WT) also differ in females with long-COVID. Our objective was to evaluate CT airway and pulmonary vascular and quality-of-life measurements in females with COPD as compared to ex-smokers and patients with long-COVID. Chest CT was acquired 3-months post-COVID-19 infection in females with long-COVID for comparison with the same inspiratory CT in female ex-smokers and COPD patients. TAC, LA, WT, and pulmonary vascular measurements were quantified. Linear regression models were adjusted for confounders including age, height, body-mass-index, lung volume, pack-years and asthma diagnosis. Twenty-one females (53 ± 14 years) with long-COVID, 17 female ex-smokers (69 ± 9 years) and 13 female COPD (67 ± 6 years) patients were evaluated. In the absence of differences in quality-of-life scores, females with long-COVID reported significantly different LA (p = 0.006) compared to ex-smokers but not COPD (p = 0.7); WT% was also different compared to COPD (p = 0.009) but not ex-smokers (p = 0.5). In addition, there was significantly greater pulmonary small vessel volume (BV5) in long-COVID as compared to female ex-smokers (p = 0.045) and COPD (p = 0.003) patients and different large (BV10) vessel volume as compared to COPD (p = 0.03). In females with long-COVID and highly abnormal quality-of-life scores, there was CT evidence of airway remodelling, similar to ex-smokers and patients with COPD, but there was no evidence of pulmonary vascular remodelling.Clinical Trial Registration: www.clinicaltrials.gov NCT05014516 and NCT02279329

Determinants of malnutrition and associated parameters in subjects with stable chronic obstructive pulmonary disease: A cross sectional study

Background: Chronic obstructive pulmonary disease exerts local and systemic manifestations including malnutrition which has deleterious consequences on health, quality of life and survival. Nutritional status is known to impact the prognosis of COPD.Aims: An attempt was made to study the nutritional status of subjects with stable COPD using PGSGA, identify malnutrition and analyze the factors contributing to malnutrition. Patients and Methods: Using convenient sampling, 110 subjects of both sexes (105 men and 5 women) with stable COPD aged between 40 – 75 years (61 ± 9 years), visiting the Pulmonologist at JSS Hospital, Mysuru were included in the study. The subjects underwent spirometry, anthropometry, evaluation of body composition, calorie intake and health related quality of life using standard methods. Differences in the parameters between groups of subjects with varying nutritional status and association with PGSGA score were statistically evaluated. Results: Moderate to severe malnutrition was seen in 59% of the subjects. The presence of GI symptoms [OR=62.217, 95% CI (10.834-357.292)], grade 4 dyspnea [OR=67.302, 95% CI (1.287-3520.295)] and increasing disease years [OR=1.151, 95% CI (1.021-1.299)] were found to significantly increase the odds of risk of malnutrition, with very severe dyspnea showing the highest risk of malnutrition followed by presence of GI symptoms. Total SGRQ scores, activity and impact scores were significantly higher in the malnourished groups (p < 0.001). The presence of nutrition impact symptoms, seen in 50% of the subjects was associated with lower calorie intake. Severe dyspnea, severe COPDand increasing disease years increased the risk of malnutrition. However, the small sample size and single-center study may not accurately represent the true proportion of malnutrition among female COPD patients in the community. Keywords: PGSGA, COPD, Malnutrition, Pulmonary function, Dyspnea.

Impact of Sex on Circulating Leukocytes Composition in COPD Patients.

PurposeChronic obstructive pulmonary disease is characterized by chronic inflammatory response both at the lung site and at the systemic level. Abnormalities in circulating leukocytes have been reported to occur in COPD patients and have been often shown to correlate with the decline in lung function. COPD affects men and women at a virtually comparable rate, even though distinct sex specific symptoms, progression and therapeutic implications have been described. Nonetheless, these sex-associated differences have not been analyzed in terms of circulating leukocytes. To assess the impact of sex on the changes of circulating immune cells in COPD patients.Patients and MethodsBlood samples were collected from 50 COPD patients (31 males, 19 females) and 63 age and sex-matched controls (35 males, 28 females) enrolled in this pilot study. Complete blood cell count and multi-parametric flow cytometry analysis were performed to characterize the leukocyte populations and subsets.ResultsMale COPD patients are distinguished from controls by a significant increase in white blood cell counts, neutrophil total and differential counts, and neutrophil-to-lymphocyte ratio. Conversely, a generalized leukocyte decrease discriminated female COPD patients from the related controls. The impact of sex is further remarked by a decrease in adaptive immune cell subpopulations in males as opposed to a consistent increase of innate immune cell types in females correlating with disease severity.ConclusionThese data indicate that the definition of specific changes of circulating leukocytes to be used as reliable biomarkers of the disease severity cannot be accomplished irrespectively of sex.

Sex differences between women and men with COPD: A new analysis of the 3CIA study

BackgroundThere is partial evidence that COPD is expressed differently in women than in men, namely on symptoms, pulmonary function, exacerbations, comorbidities or prognosis. There is a need to improve the characterization of COPD in females. MethodsWe obtained and pooled data of 17 139 patients from 22 COPD cohorts and analysed the clinical differences by sex, establishing the relationship between these characteristics in women and the prognosis and severity of the disease. Comparisons were established with standard statistics and survival analysis, including crude and multivariate Cox-regression analysis. ResultsOverall, 5355 (31.2%) women were compared with men with COPD. Women were younger, had lower pack-years, greater FEV1%, lower BMI and a greater number of exacerbations (all p < 0.05). On symptoms, women reported more dyspnea, equal cough but less expectoration (p < 0.001). There were no differences in the BODE index score in women (2.4) versus men (2.4) (p = 0.5), but the distribution of all BODE components was highly variable by sex within different thresholds of BODE. On prognosis, 5-year survival was higher in COPD females (86.9%) than in males (76.3%), p < 0.001, in all patients and within each of the specific comorbidities that we assessed. The crude and adjusted RR and 95% C.I. for death in males was 1.82 (1.69–1.96) and 1.73 (1.50–2.00), respectively. ConclusionsCOPD in women has some characteristic traits expressed differently than compared to men, mainly with more dyspnea and COPD exacerbations and less phlegm, among others, although long-term survival appears better in female COPD patients.

"Efficacy of Pelvic Floor Therapy in Treating Urinary Incontinence among Female Copd Patients"

"Efficacy of Pelvic Floor Therapy in Treating Urinary Incontinence among Female Copd Patients"

Gender differences in health-related quality of life of Korean patients with chronic obstructive lung disease.

The aim of this study was to identify the health-related quality of life (HRQOL) of COPD patients over 40 years of age in Korea and to assess the relevance of gender differences. Original data from KNHANES (Korea National Health and Nutrition Examination Survey) were analyzed using SAS 9.3 software. The sample comprised 556 male and 195 female COPD patients. Selected demographic variables, HRQOL [EuroQol 5-Dimension], physical and psychological characteristics, and health-related characteristics were examined. The results showed that the HRQOL of COPD patients was better for females than for males, and that the HRQOL among males differed with the education, economic activity, economic level, blood pressure, suicidal ideation, and physical activity, while among females it differed with age, living status, education, economic activity, economic level, blood pressure, stress recognition, suicidal ideation, alcohol use, and physical activity. Further analysis verified that for males, the education, suicidal ideation, and physical activity were factors that affected HRQOL (R(2) = 0.139, p < .001), while for females these factors were the education, obesity, and suicidal ideation (R(2) = 0.340, p < .001). Effective-health promoting interventions for COPD patients require the development of individualized programs that take into account gender-related factors that can enhance HRQOL.

Effect of modality on cardiopulmonary exercise testing in male and female COPD patients

The purpose of this study was to examine the physiological responses to treadmill and cycle cardiopulmonary exercise testing (CPET) in male and female COPD patients. Fifty-five patients [28 males (FEV1=58.2±19.5% predicted), and 27 females (FEV1=65.3±16.6% predicted)] completed a treadmill and a cycle CPET in random order on two separate days. Respiratory and cardiovascular data were obtained. Compared to the cycle CPET, the treadmill elicited greater peak power output and peak oxygen uptake, while arterial saturation at peak exercise was lower with the treadmill; however, there were no differences between the responses in men and women. No differences were observed in heart rate, ventilation, tidal volume/breathing frequency, inspiratory capacity, or dyspnea responses between modalities or sex. The physiological responses between treadmill and cycle CPET protocols are largely similar for both men and women with COPD, indicating that either modality can be used in mild/moderate COPD patients.

The prevalence of undiagnosed renal failure in a cohort of COPD patients in western Norway

Patients with COPD are at risk for other comorbid diseases, like heart failure, coronary heart disease, and depression. However, little is known about COPD phenotypes and prevalence of sub-clinical renal failure. 433 COPD patients and 233 subjects without COPD, from Western Norway, age 40-75, GOLD stage II-IV, were examined in 2006/07 upon entry to the Bergen COPD Cohort Study. Plasma creatinine was measured in 422 of the COPD patients. The Glomerular Flow Rate (GFR) was determined with the Cockcroft Gault formula, and having a GFR<60 was defined as renal failure. Examined explanatory factors were sex, age, smoking habits, GOLD stage, hypoxemia, exacerbation history, cachexia, use of daily inhaled steroids, Charlson comorbidity score, use of ACE inhibitors and/or ARBs, and the inflammatory plasma markers C-reactive protein (CRP), soluble tumor necrosis factor receptor 1 (sTNF-R1) and neutrophil gelatinase associated lipocalin (NGAL). Associations between explanatory variables and renal failure were examined by a logistic regression analysis. The prevalence of having GFR<60 was 9.6% in female COPD patients and 5.1% in male COPD patients (p=0.08). In multivariable analysis, female sex, higher age, cachexia, and the inflammatory markers sTNF-R1 and NGAL were all independently associated with a higher risk for renal failure, whereas use of inhaled steroids, Charlson score, GOLD stage, respiratory failure, and exacerbation frequency were not. Undiagnosed renal failure is a concern particularly in elderly COPD patients and COPD patients with cachexia.

Gender and skeletal muscle characteristics in subjects with chronic obstructive pulmonary disease

The influence of gender in the clinical expression of COPD has received important attention. Limited information exists regarding gender differences in the skeletal muscle characteristics in COPD subjects. The present study was aimed to determine the differences in the skeletal muscle characteristics in men and women with and without COPD. For comparison we studied 24 female (61±9 years) and 30 male (65±8 years) COPD patients with similar disease severity. In addition healthy subjects, 17 women (58±8 years), and 9 men (57±8 years) were studied. Pulmonary function, health status, six minute walk distance test (6MWD) and vastus lateralis muscle biopsy were assessed. Fiber type proportion, fiber type cross sectional area (CSA), capillary counts, and activity of citrate synthase (CS), 3-hydroxyacyl-CoA-dehydrogenase (HAD) and lactate-dehydrogenase (LDH) were determined. Pulmonary function, health status and 6MWD were similar in male and female COPD patients. Fiber type distribution was similar between women (I=42±9%, IIA=39±13%, IIX=19±7%) and men (I=39±13%, IIA=38±9%, IIX=29±10%) with COPD, as well as CSA, capillarity and enzymes (CS 8.59±1.6 vs.9.74±2.6, HAD 9.03±1.9 vs. 9.84±2.5, LDH 124±48 vs. 151±68μmolmin(-1)g(-1)). In normal subjects a decrease in type IIX fibers CSA was found in women compared with men (3703±1478 vs. 5426±1386μm(2), respectively). Female and male with COPD have similar skeletal muscle characteristics; it is possible that the disease blurs the gender differences. On the other hand, there seems to be fewer differences in muscle characteristics between older men and women, perhaps due to lower male testosterone levels and physical inactivity.

Comorbidity and gender-related differences in patients hospitalized for COPD. The ECCO study

Patients hospitalized for a COPD exacerbation are usually of advanced age, with functional deterioration, and suffering an increased number of associated conditions, but little is known about gender differences. Our hypothesis is that the frequency and type of comorbidities differ in male and female COPD patients. A cross-sectional, multicentre study of patients hospitalized for a COPD exacerbation. All of them had COPD confirmed by baseline forced spirometry with a bronchodilator test. Comorbidity information was collected using the Charlson index, and an ad hoc questionnaire that included other common conditions not included in the Charlson index. We studied 398 patients, 353 men (89%) and 45 women (11%), with a mean (S.D.) age of 73.7 (8.9) years and a percent predicted FEV(1) of 43.2 (12.5). The mean score of the Charlson index was 2.7 (2.0), with no differences by gender; in contrast, the mean number of all comorbid conditions assessed was 3.7 (1.7) in men and 1.8 (1.8) in women (p < 0.05). Overall, 55% of the patients had arterial hypertension, 26% diabetes mellitus, 27% chronic heart failure, and 17% ischemic heart disease. Female COPD patients had a lower prevalence of ischemic heart disease (p = 0.008) and alcoholism (p = 0.03), but presented more frequently with chronic heart failure (p = 0.03), osteoporosis (p = 0.007) and diabetes mellitus without complications (p = 0.02). Comorbidities are common in patients hospitalized for a COPD exacerbation, but their relative distribution varies by gender. The exclusive use of the Charlson index underestimates comorbidities in COPD patients.

Significantly higher prevalence of cad in asymptomatic male smokers as compared with their female counterparts

Objective: The incidence of coronary artery disease (CAD) as detected by myocardial perfusion imaging (MPI) in asymptomatic smokers is unknown. The objective was to compare the prevalence of CAD among male and female smokers who underwent dobutamine (DBA) stress test with MPI. Methods: We performed a retrospective cohort study on 192 smokers (99 males, mean age 70 + 11 years and 93 females, mean age 72 + 10 years) with severe COPD and no history of CAD, referred for DBA stress MPI for non-vascular elective surgeries. Clinical risks score for CAD were similar in both groups except more women had diabetes and hyperlipidemia than men. There was no significant difference in the number of pack years of cigarettes smoked. All patients achieved > 85% of predicted maximal heart rate with DBA infusion. Results: Overall 64 /192 (33%) had myocardial perfusion defects. The prevalence of defects among males was 53/99 (55%) versus 11/93 (12%) among females, p <0.001. The relative risk of CAD in males was 4.5 times compared to females. The prevalence of multi-vessel disease was higher in men than in women (30% vs 9%), p<0.001. Conclusion: In this study, we found a high prevalence of CAD among male asymptomatic COPD patients with extensive smoking history, compared with age and risk factor matched female asymptomatic COPD patients. Pulmonary limitations in males with severe COPD may mask their CAD.

PHYSICAL PERFORMANCE CHANGES IN MALE AND FEMALE PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE(COPD)

1831 The purpose of this investigation was to evaluate the changes in physical performance in male and female patients with COPD following a twelve-week exercise intervention. The study population included 44 male/female pairs that were matched based on age and severity of disease. Graded exercise tests and physical performance tests were administered prior to and following the 12-week exercise intervention. Significant improvements for both male and female patients were made in the six-minute walk distance (235.9±33.2 and 196.5±20.5 ft, respectively), the time to complete an overhead task (−5.0±2.0 and −3.8±1.7 sec, respectively), and total treadmill time (0.45±0.16 and 0.43±0.16 sec, respectively). The stair climb time significantly improved in the female patients (−0.80±0.30 sec), but it did not significantly improve in the male patients (−0.17±0.31 sec). Additionally, the peak oxygen consumption significantly increased in the male patients (0.77±0.26 ml·kg−1·min−1), but it did not significantly improve in the female patients (0.47±0.16 ml·kg−1·min−1). There were no significant (p > 0.05) differences when comparing the improvements in physical performance made by male patients from baseline to follow-up versus the improvements made by the female patients from baseline to follow-up. The results of this investigation suggest that improvements in physical function occur similarly in male and female COPD patients following a 12-week exercise intervention. Supported NIH HL53755