Browse ATS 2021 Abstracts

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ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.

Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.

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Sex Differences in Airways: Implications for Chronic Obstructive Pulmonary Disease

Session Title
C5 - C005 DIAGNOSIS AND PROGNOSIS IN COPD
Abstract
A1120 - Sex Differences in Airways: Implications for Chronic Obstructive Pulmonary Disease
Author Block: S. P. Bhatt1, S. Bodduluri1, A. Nakhmani2, Y. Kim3, J. M. Reinhardt4, E. A. Hoffman5, A. Motahari6, J. Charbonnier7, S. M. Humphries8, E. A. Regan9, D. L. DeMeo10; 1Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States, 2Electrical and Computer Engineering, University of Alabama at Birmingham, Birmingham, AL, United States, 3Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, United States, 4Biomedical Engineering, The University of Iowa, Iowa City, IA, United States, 5Univ of Iowa Carver Coll of Med, Iowa City, IA, United States, 6Radiology, University of Iowa, Iowa City, IA, United States, 7Thirona, Nijmegen, Netherlands, 8Dept of Radiology, National Jewish Health, Denver, CO, United States, 9National Jewish Health, Denver, CO, United States, 10Brigham and Womens Hosp, Boston, MA, United States.
Rationale: Chronic obstructive pulmonary disease (COPD) is more frequently diagnosed in men than in women, but the prevalence of COPD in women is fast approaching that in men. Amongst smokers, men have more emphysema than women after accounting for smoking burden and lung function. Structural differences in airways may underlie some of the sex differences in COPD.
Methods: We included 423 lifetime non-smokers and 9,364 current and former smokers from the Genetic Epidemiology of COPD (COPDGene) cohort. Sex was verified using chromosomal information. Using baseline CT scans acquired at end inspiration, we quantified airway disease using Airway Wall Thickness of segmental airways (AWT), Wall Area percent (WA%) of segmental airways, Pi10, the square root of the wall area of a hypothetical airway with 10 mm internal perimeter, Hydraulic lumen diameter of segmental airways, Airway volume, Total Airway Count (TAC), and Airway Fractal Dimension (AFD), a measure of the complex branching pattern and luminal size. In both never- and ever-smokers, we created generalized linear regression (GLM) models with each airway metric as dependent variable and sex as independent variable. These models were adjusted for height, age, race, BMI, pack-years of smoking, current smoking status, total lung capacity, display field of view, and CT scanner type. Least squares means were compared by sex using t-test. In ever-smokers, we created separate GLM models in men and women with clinical outcomes as the dependent variable (post-bronchodilator FEV1/FVC, mMRC, SGRQ, and 6-minute walk distance) and airway metric as independent variable. Multivariable Cox proportional hazards models were similarly created to assess differences in airway metrics and survival by sex.
Results: Men had thicker airway walls than women in never-smokers, whereas lumen characteristics were not different by sex, except smaller airway volume in women (Table 1). In ever-smokers, wall thickness was greater in men but all lumen parameters were worse in women. A unit change in each of the airway metrics, wall or lumen, resulted in worse FEV1/FVC, dyspnea, respiratory-quality of life, and 6-minute walk distance in women compared with men (all p<0.01). A unit change in each of the airway metrics was also associated with worse survival in women than in men (all p<0.01).
Conclusions: There are innate differences in airway structure between men and women. Airway remodeling is accentuated in ever-smoker females, and these airway remodeling changes have a greater impact on respiratory morbidity and all-cause mortality in women than in men.