The Clinical Respiratory Journal
ORIGINAL ARTICLE
Gender differences of chronic obstructive pulmonary disease associated with manifestations on HRCT ShuYi Gu1,2, XiaoJun Deng3, QingYun Li1, XianWen Sun1, JinFu Xu2 and HuiPing Li2 1 Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China 2 Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China 3 Department of Emergency, The Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
Abstract Background and Aims: Patients with chronic obstructive pulmonary disease (COPD) have been shown to have significant gender differences in terms of susceptibility, severity and response to therapy. We hypothesized that this was due to differences in functional and pathologic changes in the airway, which can be revealed by high-resolution computed tomography (HRCT) in addition to pulmonary function test (PFT). Methods: A total of 84 patients with COPD were enrolled in the study. Within 1 week of enrollment, a history of each patient’s current illness was obtained. PFT and chest HRCT scan were performed. Results: The patients were classified as phenotype A, E and M based on the chest HRCT presentations. No significant gender differences were found in COPD severity (χ2 = 4.993, P = 0.172). Male patients have more smoking history and smaller average age compared with female patients. Female patients showed a significantly higher FEV1/FVC, lower inspiratory capacity and milder residual volume/total lung capacity than that of male patients. Based on the HRCT results, more males were classified as phenotype M, whereas females tended to be phenotype A. Males had a greater grade of low attenuation areas and were more likely to show evidence of emphysema on a HRCT scan than females (χ2 = 15.373, P = 0.001), whereas females had less airway wall thickening than males, although this change had no statistical significance. (χ2 = 0.163, P = 0.922). Conclusion: Gender differences of COPD patients were seen in ages of onset, smoking history, and PFT and HRCT presentations. The use of HRCT imaging indicates that there are significant gender differences in the clinical manifestations of COPD. Please cite this paper as: Gu SY, Deng XJ, Li QY, Sun XW, Xu JF and Li HP. Gender differences of chronic obstructive pulmonary disease associated with manifestations on HRCT. Clin Respir J 2015; ••: ••–••. DOI:10.1111/crj.12297.
Ethics This study was approved by the Research Ethics Committee of Ruijin Hospital, and all patients gave their written informed consent for participation.
Conflict of interest The authors have stated explicitly that there are no conflicts of interest in connection with this article.
The Clinical Respiratory Journal (2015) • ISSN 1752-6981 © 2015 John Wiley & Sons Ltd
Key words chronic obstructive pulmonary disease (COPD) – gender – high-resolution computed tomography (HRCT) – pulmonary function test (PFT) Correspondence QingYun Li, MD, PhD, Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, 200025 Shanghai, China. Tel: 86 21 64370045 680828 Fax: +86 021 6431 4162 email: [email protected] JinFu Xu, MD, PhD, Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, 507 Zhengmin Road, 200433 Shanghai, China. Tel: 86 21 65115006 2094 Fax: +86 021 65115006 email: [email protected] Received: 13 July 2014 Revision requested: 07 March 2015 Accepted: 23 March 2015 DOI:10.1111/crj.12297 Authorship and contributorship QingYun Li, ShuYi Gu and JinFu Xu designed the study and revised this paper. ShuYi Gu, XiaoJun Deng and XianWen Sun searched the database, judged study eligibility, extracted data and drafted the main part of the article. ShuYi Gu and XiaoJun Deng did the meta-analyses. HuiPing Li also drafted part of the article and revised this article. ShuYi Gu and XiaoJun Deng contributed equally to this work as co-first authors. QingYun Li and JinFu Xu contributed equally to this work as co-corresponding authors. All authors have read and approve this version of the article.
1
Gender differences of COPD associated with HRCT
Introduction For many years, chronic obstructive pulmonary disease (COPD) was considered a disease of men, with higher global prevalence in men than in women. Since the 1980s, the prevalence, morbidity and mortality of COPD among women has been rapidly rising (1, 2). Therefore, more researchers have been paying attention to female patients with COPD, and recent studies have revealed potentially substantial gender differences in disease susceptibility, severity and response to therapy in patients with COPD (3–6). In recent years, pulmonary function tests (PFTs) have been used as the gold standard for the diagnosis and assessment of patients with COPD (7). But this type of severity assessment does not recognize the range of pathophysiological abnormalities that may be present in this heterogeneous condition (8, 9). Also PFTs are known to be relatively insensitive to both early stages and small changes of manifest disease [i.e. less than 25% of the lung affected (10)]. Clinically, even male and female patients with same results of PFTs show different syndromes; some patients show production of greater amounts of sputum and wheezing, and some complain of severe dyspnea or mild hypoxemia. Facts that induced gender differences of COPD have not emerged. COPD is a heterogeneous disease affecting the airways and/or the parenchyma with different severity during the course of the disease. Therefore, in order to improve the identification and long-term care for patients with COPD, new measures are required for improved assessment of morphological and functional impairment and contribution of each aspect to the patients’ symptoms. Also, the identification and subsequent grouping of key elements of the COPD syndrome into clinically meaningful and useful phenotypes is a potential solution to express the gender difference. High-resolution computed tomography (HRCT) scanning allows for an in vivo analysis of the type and distribution of morphological changes in COPD patients. In this study, the HRCT phenotype of COPD was performed to characterize different patient populations to allow for better stratification, and can clearly observe gender differences in symptoms, PFTs, prognosis and also impact therapeutic decision making.
Materials and methods Subjects A total of 117 stable COPD patients were recruited from the Department of Respiratory Medicine of
2
Gu et al.
Ruijin Hospital, Shanghai Jiaotong University School of Medicine. The age of patients ranged from 34 to 81 years with a mean age of 67 ± 11 years. COPD was diagnosed based on clinical history and symptoms including constant dyspnea on exertion and pulmonary function characterized by irreversible airflow limitation (FEV1/FVC
ORIGINAL ARTICLE
Gender differences of chronic obstructive pulmonary disease associated with manifestations on HRCT ShuYi Gu1,2, XiaoJun Deng3, QingYun Li1, XianWen Sun1, JinFu Xu2 and HuiPing Li2 1 Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China 2 Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China 3 Department of Emergency, The Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China
Abstract Background and Aims: Patients with chronic obstructive pulmonary disease (COPD) have been shown to have significant gender differences in terms of susceptibility, severity and response to therapy. We hypothesized that this was due to differences in functional and pathologic changes in the airway, which can be revealed by high-resolution computed tomography (HRCT) in addition to pulmonary function test (PFT). Methods: A total of 84 patients with COPD were enrolled in the study. Within 1 week of enrollment, a history of each patient’s current illness was obtained. PFT and chest HRCT scan were performed. Results: The patients were classified as phenotype A, E and M based on the chest HRCT presentations. No significant gender differences were found in COPD severity (χ2 = 4.993, P = 0.172). Male patients have more smoking history and smaller average age compared with female patients. Female patients showed a significantly higher FEV1/FVC, lower inspiratory capacity and milder residual volume/total lung capacity than that of male patients. Based on the HRCT results, more males were classified as phenotype M, whereas females tended to be phenotype A. Males had a greater grade of low attenuation areas and were more likely to show evidence of emphysema on a HRCT scan than females (χ2 = 15.373, P = 0.001), whereas females had less airway wall thickening than males, although this change had no statistical significance. (χ2 = 0.163, P = 0.922). Conclusion: Gender differences of COPD patients were seen in ages of onset, smoking history, and PFT and HRCT presentations. The use of HRCT imaging indicates that there are significant gender differences in the clinical manifestations of COPD. Please cite this paper as: Gu SY, Deng XJ, Li QY, Sun XW, Xu JF and Li HP. Gender differences of chronic obstructive pulmonary disease associated with manifestations on HRCT. Clin Respir J 2015; ••: ••–••. DOI:10.1111/crj.12297.
Ethics This study was approved by the Research Ethics Committee of Ruijin Hospital, and all patients gave their written informed consent for participation.
Conflict of interest The authors have stated explicitly that there are no conflicts of interest in connection with this article.
The Clinical Respiratory Journal (2015) • ISSN 1752-6981 © 2015 John Wiley & Sons Ltd
Key words chronic obstructive pulmonary disease (COPD) – gender – high-resolution computed tomography (HRCT) – pulmonary function test (PFT) Correspondence QingYun Li, MD, PhD, Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, 200025 Shanghai, China. Tel: 86 21 64370045 680828 Fax: +86 021 6431 4162 email: [email protected] JinFu Xu, MD, PhD, Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, 507 Zhengmin Road, 200433 Shanghai, China. Tel: 86 21 65115006 2094 Fax: +86 021 65115006 email: [email protected] Received: 13 July 2014 Revision requested: 07 March 2015 Accepted: 23 March 2015 DOI:10.1111/crj.12297 Authorship and contributorship QingYun Li, ShuYi Gu and JinFu Xu designed the study and revised this paper. ShuYi Gu, XiaoJun Deng and XianWen Sun searched the database, judged study eligibility, extracted data and drafted the main part of the article. ShuYi Gu and XiaoJun Deng did the meta-analyses. HuiPing Li also drafted part of the article and revised this article. ShuYi Gu and XiaoJun Deng contributed equally to this work as co-first authors. QingYun Li and JinFu Xu contributed equally to this work as co-corresponding authors. All authors have read and approve this version of the article.
1
Gender differences of COPD associated with HRCT
Introduction For many years, chronic obstructive pulmonary disease (COPD) was considered a disease of men, with higher global prevalence in men than in women. Since the 1980s, the prevalence, morbidity and mortality of COPD among women has been rapidly rising (1, 2). Therefore, more researchers have been paying attention to female patients with COPD, and recent studies have revealed potentially substantial gender differences in disease susceptibility, severity and response to therapy in patients with COPD (3–6). In recent years, pulmonary function tests (PFTs) have been used as the gold standard for the diagnosis and assessment of patients with COPD (7). But this type of severity assessment does not recognize the range of pathophysiological abnormalities that may be present in this heterogeneous condition (8, 9). Also PFTs are known to be relatively insensitive to both early stages and small changes of manifest disease [i.e. less than 25% of the lung affected (10)]. Clinically, even male and female patients with same results of PFTs show different syndromes; some patients show production of greater amounts of sputum and wheezing, and some complain of severe dyspnea or mild hypoxemia. Facts that induced gender differences of COPD have not emerged. COPD is a heterogeneous disease affecting the airways and/or the parenchyma with different severity during the course of the disease. Therefore, in order to improve the identification and long-term care for patients with COPD, new measures are required for improved assessment of morphological and functional impairment and contribution of each aspect to the patients’ symptoms. Also, the identification and subsequent grouping of key elements of the COPD syndrome into clinically meaningful and useful phenotypes is a potential solution to express the gender difference. High-resolution computed tomography (HRCT) scanning allows for an in vivo analysis of the type and distribution of morphological changes in COPD patients. In this study, the HRCT phenotype of COPD was performed to characterize different patient populations to allow for better stratification, and can clearly observe gender differences in symptoms, PFTs, prognosis and also impact therapeutic decision making.
Materials and methods Subjects A total of 117 stable COPD patients were recruited from the Department of Respiratory Medicine of
2
Gu et al.
Ruijin Hospital, Shanghai Jiaotong University School of Medicine. The age of patients ranged from 34 to 81 years with a mean age of 67 ± 11 years. COPD was diagnosed based on clinical history and symptoms including constant dyspnea on exertion and pulmonary function characterized by irreversible airflow limitation (FEV1/FVC
