For Immediate Release
Contact:
Bill Glitz
Jim Augustine
Mike White
ALA/ATS Press Room at 312-808-2005
GENDER DIFFERENCES SEEN IN ASTHMA, COPD AND SLEEP APNEA
CHICAGO, April 27-New studies presented here at the American Lung
Association/American Thoracic Society International Conference indicate
that there are gender differences in the diagnosis, treatment and
response to lung disease. At a press panel today, researchers described
gender differences in three common lung diseases-asthma, chronic
obstructive pulmonary disease and obstructive sleep apnea.
It is not clear whether these gender differences are true
physiological/biological differences, or whether the gender gap is
largely due to men's and women's reactions to the symptoms of lung
disease, said Sonia Buist, M.D. of the Oregon Health Sciences University
in Portland, who moderated the press panel. However one important factor
in the lung disease gender gap is physician bias, Dr. Buist said.
"Physicians may not be as aggressive in preventive therapy with women as
with men, and they may not be as aggressive in achieving good control in
women."
One study on gender and chronic obstructive pulmonary disease (COPD)
suggests that COPD may have a greater impact on the quality of life of
women compared with men. COPD, the umbrella term for emphysema and
chronic bronchitis, affects nearly 16 million Americans.
"People with chronic bronchitis and emphysema experience problems with
shortness of breath on exertion. They get very short of breath with even
mild forms of exertion. And they experience problems with fatigue. This
is very likely to affect their quality of life," said study lead author
Janet Larson, Ph.D. She and colleagues at the University of Illinois at
Chicago surveyed 83 people with moderate to severe COPD, and although
they found no gender differences in severity of disease or symptoms,
women reported having a lower quality of life and lower emotional
functioning compared with men.
"We don't know why women with COPD have a lower quality of life compared
with men, but it may be that women's multiple roles make their lives so
complex that the breathing problems caused by this chronic disease have
a greater impact on them," said Dr. Larson. "People with COPD often are
in their middle 60s. When women retire from the work force or when they
become too disabled to continue working they stay home. But they still
have the housework to do and they may have grandchildren for whom they
provide daycare. This may account for the differences in impact between
men and women."
Researchers may need to design gender-specific interventions for people
with lung disease, Dr. Larson noted. "For instance, women in their
mid-60s tend not to be physically fit, and this is one factor that
should be looked at. It's been an ignored issue until now."
Asthma also may take a greater toll on women, another study presented at
the conference suggests. Researchers at the University of Calgary
studied patients ages 5 to 50 who were admitted to the intensive care
unit for asthma. They found that women whose asthma requires treatment
in the intensive care unit have more severe disease, more use of asthma
medications, more asthma triggers and more symptoms such as night waking
compared with men.
Lead researcher Ian Mitchell, M.D., said that a striking finding was
that 11 of the 13 current smokers in the study were female. Smoking is a
health danger for everyone, but it has an immediate detrimental impact
on people with asthma because it is a potent asthma trigger. "If you
look at cigarette advertising in magazines, it's obvious that many of
them are very specifically targeted to young women," he said.
The study also found that males in the study typically had been
diagnosed with asthma before age 5, while there was no typical age of
diagnosis for females. "It could be that doctors aren't as likely to
consider an asthma diagnosis for girls, or there could be a biological
basis for the difference in the age at which asthma develops in males
and females," Dr. Mitchell said.
The study suggests that doctors may treat asthma differently in men and
women, he said. One way women with asthma can help prevent this gender
bias is to not minimize their asthma symptoms when they speak to their
physician, Dr. Mitchell said. "And physicians need to recognize that
women do tend to minimize their symptoms, and so they should question
their female patients more closely about symptoms."
A third lung disease that appears to affect males and females
differently is the nighttime breathing problem known as obstructive
sleep apnea. Unlike COPD and asthma, sleep apnea's toll is greater on
men. But a study presented at the conference suggests that while sleep
apnea is more common and severe in men, sleep apnea that occurs during
rapid eye movement (REM) sleep is more common in women. Dreaming takes
place during REM sleep. The study findings may reflect differences in
the control of breathing and upper airway function between men and
women, according to the researchers from the University of Toronto.
The study looked at 855 patients with sleep apnea, and found that
overall, men were more than three times as likely as women to suffer
from sleep apnea, and seven times as likely to suffer from severe sleep
apnea. However, sleep apnea occurring during REM sleep was
disproportionately more common in women than in men.
Lead researcher Chris O'Connor, M.D., explained that during REM sleep,
which accounts for about 20% of total sleep time, the body loses muscle
tone everywhere, including the airways. "Women seem to have some
functional advantage in non-REM sleep, when they aren't dreaming, which
they lose during REM sleep, when the body relaxes," he said. "This helps
explain why women aren't as affected by sleep apnea."
The findings also suggest that researchers may need to re-examine how
women are treated for sleep apnea, Dr. O'Connor said.
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