- Email: [email protected]
Heterogeneity in COPD: A need for better characterisation
ARTICLE IN PRESS R E S P I R AT O RY M E D I C I N E : C O P D U P D AT E
3 (2007) 119 – 127
121
may also drive the over-production of active TGFb in cells at higher density. Thus cigarette smoke could contribute to airways fibrosis as well as to emphysema. Recognition of the structural changes present in COPD that lead to physiologic alterations creates potential targets for treatment designed to alter the progression of COPD or to restore normal function. 10.1016/j.rmedu.2007.07.017
Gender differences in COPD
Francine Kauffmann Epidemiology and Biostatistics, Inserm U780, Villejuif, France E-mail address: [email protected] Gender-related differences in environmental risk factors (smoking, occupation), sex-specific endogenous or exogenous hormonal factors, sex-specific physiological characteristics (immunological, lung function dimensions, triggered cough), gender-related differences in report, or perception of symptoms (phlegm, dyspnea) all concur to differences in the presentation of obstructive diseases, such as COPD between men and women. Furthermore, results are emerging regarding sex-specific genetic factors in respiratory diseases. Drug trials also showed sex-specific effects, but gender differences in treatment response and prognosis remain poorly understood. Research is starting regarding the effect of hormone-related events, although more research is conducted in asthma than in COPD. Interest is increasing in gender-related medicine at various levels and a more systematic approach would be necessary. At the research level, analyses should be conducted systematically by stratifying on gender, instead of immediate adjustment. At the clinical level, gender-specific presentation in COPD should be taken into account. Considering gender differences in COPD is a means better to understand the etiology and the evolution of COPD and to disentangle COPD subphenotypes. It may ultimately be useful to propose gender-specific disease management. F U R T H E R
R E A D I N G
1. Becklake MR, Kauffmann F. Gender differences in airway behaviour over the human life span. Thorax 1999;54:1119–38. 2. Jenkins C. Mars and Venus in the GP’s office. Eur Respir J 2006;28:259–61.
10.1016/j.rmedu.2007.07.018
Heterogeneity in COPD: A need for better characterisation JørgenVestbo Hvidovre University Hospital (DK)/Wythenshawe Hospital (UK). E-mail address: [email protected] According to current guidelines COPD is diagnosed and categorised using spirometric parameters, in particular the FEV1 and the FVC, and the change in FEV1 over time is the most widely accepted measure of disease progression. Unfortunately, FEV1 does not provide a complete picture of COPD. Quantitative morphometric analysis on post mortem and surgical lung specimens as well as radiographic studies using HRCT show that FEV1 is insensitive to anatomic disease severity in COPD. Thus, patients with a similar FEV1 may have very different underlying pathology. In some cases there may be widespread parenchymal destruction while in others there may be predominant increases in airway wall thickness, with consequent airflow obstruction. This type of observation has important implications. Different subtypes of COPD could very well have different relative impact of risk factors, different natural histories, and indeed different response to therapy. For instance, a therapy aimed mainly at preventing lung destruction might have little or no effect in patients with airway inflammation and increased airway wall thickness. There is therefore a need for new approaches to characterise patients with COPD and an era of ‘‘lumping’’ may have to give way to years of ‘‘splitting’’.
10.1016/j.rmedu.2007.07.019
3 (2007) 119 – 127
121
may also drive the over-production of active TGFb in cells at higher density. Thus cigarette smoke could contribute to airways fibrosis as well as to emphysema. Recognition of the structural changes present in COPD that lead to physiologic alterations creates potential targets for treatment designed to alter the progression of COPD or to restore normal function. 10.1016/j.rmedu.2007.07.017
Gender differences in COPD
Francine Kauffmann Epidemiology and Biostatistics, Inserm U780, Villejuif, France E-mail address: [email protected] Gender-related differences in environmental risk factors (smoking, occupation), sex-specific endogenous or exogenous hormonal factors, sex-specific physiological characteristics (immunological, lung function dimensions, triggered cough), gender-related differences in report, or perception of symptoms (phlegm, dyspnea) all concur to differences in the presentation of obstructive diseases, such as COPD between men and women. Furthermore, results are emerging regarding sex-specific genetic factors in respiratory diseases. Drug trials also showed sex-specific effects, but gender differences in treatment response and prognosis remain poorly understood. Research is starting regarding the effect of hormone-related events, although more research is conducted in asthma than in COPD. Interest is increasing in gender-related medicine at various levels and a more systematic approach would be necessary. At the research level, analyses should be conducted systematically by stratifying on gender, instead of immediate adjustment. At the clinical level, gender-specific presentation in COPD should be taken into account. Considering gender differences in COPD is a means better to understand the etiology and the evolution of COPD and to disentangle COPD subphenotypes. It may ultimately be useful to propose gender-specific disease management. F U R T H E R
R E A D I N G
1. Becklake MR, Kauffmann F. Gender differences in airway behaviour over the human life span. Thorax 1999;54:1119–38. 2. Jenkins C. Mars and Venus in the GP’s office. Eur Respir J 2006;28:259–61.
10.1016/j.rmedu.2007.07.018
Heterogeneity in COPD: A need for better characterisation JørgenVestbo Hvidovre University Hospital (DK)/Wythenshawe Hospital (UK). E-mail address: [email protected] According to current guidelines COPD is diagnosed and categorised using spirometric parameters, in particular the FEV1 and the FVC, and the change in FEV1 over time is the most widely accepted measure of disease progression. Unfortunately, FEV1 does not provide a complete picture of COPD. Quantitative morphometric analysis on post mortem and surgical lung specimens as well as radiographic studies using HRCT show that FEV1 is insensitive to anatomic disease severity in COPD. Thus, patients with a similar FEV1 may have very different underlying pathology. In some cases there may be widespread parenchymal destruction while in others there may be predominant increases in airway wall thickness, with consequent airflow obstruction. This type of observation has important implications. Different subtypes of COPD could very well have different relative impact of risk factors, different natural histories, and indeed different response to therapy. For instance, a therapy aimed mainly at preventing lung destruction might have little or no effect in patients with airway inflammation and increased airway wall thickness. There is therefore a need for new approaches to characterise patients with COPD and an era of ‘‘lumping’’ may have to give way to years of ‘‘splitting’’.
10.1016/j.rmedu.2007.07.019