Gender differences of chronic obstructive pulmonary disease associated with manifestations on HRCT

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.