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Just breathe: a review of sex and gender in chronic lung disease

Ranjani Somayaji, James D. Chalmers
European Respiratory Review 2022 31: 210111; DOI: 10.1183/16000617.0111-2021
Ranjani Somayaji
1Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
2Dept of Microbiology, Immunology and Infectious Disease, University of Calgary, Calgary, Canada
3Dept of Community Health Sciences, University of Calgary, Calgary, Canada
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  • For correspondence: rsomayaj@ucalgary.ca
James D. Chalmers
4Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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  • FIGURE 1
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    FIGURE 1

    All-age and sex-based chronic respiratory disease prevalence by country in 1990 and 2017. Reproduced with permission from the Institute of Health Metrics and Evaluation Global Burden of Disease project [18].

  • FIGURE 2
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    FIGURE 2

    Postulated mechanisms by sex for chronic lung disease. Pink: female; blue: male. CFTR: cystic fibrosis transmembrane conductance regulator; IL: interleukin; NTM: non-tuberculous mycobacteria; P. aeruginosa: Pseudomonas aeruginosa; SARS-CoV-2: severe acute respiratory syndrome-coronavirus-2.

Tables

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  • TABLE 1

    Differences in the epidemiology, outcomes and treatment of chronic lung diseases

    DiseaseEpidemiologyPhenotype/prognosisTreatment
    AsthmaChildhood boys >girls
    Adulthood females >males
    Severe asthma females >males
    Females have more non-allergic asthma
    Higher frequency of hospitalisation in females
    Worse quality of life in females
    Females may have more Th2 low disease
    Bronchiectasis∼70% female globallyMales have worse lung function and more severe disease
    Worse symptoms, increased cough in females
    High frequency of P. aeruginosa and NTM in females
    No sex-related differences Increased awareness of NTM in females
    COPDClassically male disease but prevalence increasing in females
    Diagnostic bias in favour of males
    Females have more small airways disease, less emphysema, worse quality of life, more anxiety and depression and more rapid lung function declineNo sex-related differences in treatment
    CFEqual disease prevalence (genetic)
    Diagnostic bias in favour of males
    Decreased survival in females
    Greater rate of pulmonary exacerbations (post-puberty)
    Earlier acquisition of P. aeruginosa in females (and greater lung function decline)
    Worse quality of life, greater depression in females
    Discouragement of treatment, acceptance of being underweight in young females
    IPFGreater prevalence in malesImproved post-transplant outcomes, survival in females
    Greater symptom burden and worse health-related quality of life in females
    No data
    PAHGreater prevalence in femalesDecreased survival in males (“oestrogen paradox”)Sex-related differences in response to commonly used therapies
    SBDGreater prevalence in males; middle-aged men thought to be most vulnerable
    Diagnostic bias in favour of males
    Differing symptoms between males and females
    Greater severity in males
    Susceptibility may increase in females with obesity, pregnancy, menopause; maternal SBD may impact neonatal outcomes
    No data

    COPD: chronic obstructive pulmonary disease; CF: cystic fibrosis; IPF: interstitial pulmonary fibrosis; NTM: non-tuberculous mycobacteria; P. aeruginosa: Pseudomonas aeruginosa; PAH: pulmonary arterial hypertension; SBD: sleep-related breathing disorders.

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    Just breathe: a review of sex and gender in chronic lung disease
    Ranjani Somayaji, James D. Chalmers
    European Respiratory Review Mar 2022, 31 (163) 210111; DOI: 10.1183/16000617.0111-2021

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    Just breathe: a review of sex and gender in chronic lung disease
    Ranjani Somayaji, James D. Chalmers
    European Respiratory Review Mar 2022, 31 (163) 210111; DOI: 10.1183/16000617.0111-2021
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    • Article
      • Abstract
      • Abstract
      • Introduction
      • Sex and gender as a health determinant
      • Sex and gender impacts on lung disease
      • COPD
      • Asthma
      • Bronchiectasis and cystic fibrosis (CF)
      • Other lung diseases
      • COVID-19
      • A way forward
      • Conclusion
      • Footnotes
      • References
    • Figures & Data
    • Info & Metrics
    • PDF

    Subjects

    • Respiratory clinical practice
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    Series

    • Sex, gender and pulmonary physiology of exercise
    • Sex-based differences in lung cancer
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    Sex and gender in lung disease

    • Sex, gender and pulmonary physiology of exercise
    • Sex-based differences in lung cancer
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