Though men and women with COPD experienced similar benefits in lung function measures, women reported larger improvements in CAT and SGRQ scores than men.

By Anaya Malik


RT’s Three Key Takeaways:

  1. Comparable physiological response – Men and women undergoing bronchoscopic lung volume reduction showed similar short-term improvements in lung function measures, including FEV₁, residual volume, and DLCO.
  2. Greater patient-reported benefit in women – Despite similar physiological gains, women experienced significantly larger improvements in symptom burden and quality of life, as measured by CAT and SGRQ scores.
  3. Sex as an independent predictor of quality-of-life response – Female sex independently predicted a higher likelihood of meaningful SGRQ improvement, suggesting sex may be important when interpreting patient-reported outcomes and defining clinically important differences in COPD.


Endoscopic lung volume reduction (LVR) is increasingly used in COPD with severe hyperinflation, yet sex specific outcome data have been limited. A retrospective analysis from the German Lung Emphysema Registry evaluated outcomes after LVR with bronchoscopic valve placement between January 2017 and January 2025.

The final cohort included 778 patients, with women comprising 47.2% and a mean age of 65.9 years. Age and BMI did not differ significantly by sex. At baseline, women had slightly higher forced expiratory volume in 1 second percent predicted and vital capacity percent predicted compared with men, while residual volume percent predicted was similar.

Men had higher rates of cardiovascular comorbidities, including coronary artery disease and atrial fibrillation. Despite these differences, women reported a higher symptom burden as reflected by higher COPD Assessment Test (CAT) scores, while St. George’s Respiratory Questionnaire (SGRQ) scores were similar between groups.

Endoscopic Lung Volume Reduction and Patient Reported Outcomes

Among 574 patients with 3 month follow up, LVR physiological responses appeared similar by sex. Changes in FEV1 percent, residual volume percent, and diffusing capacity of the lung for carbon monoxide percent did not differ significantly between women and men.

In contrast, patient reported outcomes favored women. Women experienced larger improvements in CAT and SGRQ scores than men, while dyspnea outcomes did not show a sex related difference. In multivariable analyses, female sex was an independent predictor of SGRQ response (odds ratio 1.89), alongside emphysema heterogeneity and pulmonary function response measured by change in residual volume.

The findings suggest sex may not influence short term physiological outcomes after LVR, but may meaningfully shape symptom experience and quality of life response. The authors raise whether sex should be considered when defining minimal clinically important differences in COPD outcomes.


Reference

Atug E et al. Sex differences in outcome after endoscopic lung volume reduction (ELVR) in patients with emphysema: a retrospective analysis of the German Lung Emphysema Registry (LER e.V.). Thorax. 2025;doi:10.1136/thorax-2025-223559.

This article was originally published by EMJ and was made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.