SESSION TITLE: COPD Diagnosis & Evaluation Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM
PURPOSE: To explore sex-based differences in dyspnea, daily physical activity and exercise capacity in COPD vs Controls.
METHODS: Post hoc exploratory analysis of GOLD 1&2 symptomatic COPD patients (48 men; 56 women) current/ex-smokers, age ≥40 y, with dynamic hyperinflation compared with age-matched, nonsmoker Controls (NCT01072396). Exercise capacity was assessed by incremental treadmill exercise testing (IET). Daily energy expenditure and physical activity were assessed over 14 days using a BodyMedia® accelerometer. Adjusted sex difference (ASD) was estimated using linear regression or mixed model for exercise data.
RESULTS: Women had significantly lower daily physical activity duration than men (P<.001) in both groups (mean±SD, 0.8±0.8 vs 1.8±1.5 h [COPD]; 1.2±0.8 vs 2.0±2.0 [Controls]), with COPD women being most affected (P=.002). ASDs for daily physical activity were similar between COPD and Controls for duration (-0.81 h, P<.001; -0.82, P=.007); energy expenditure (-730 Cal, P<.001; -746, P<.001); metabolic equivalents (-0.15, P<.001; -0.13, P<.001); and steps (-1596, P=.039; -1562, P=.017). Women had lower VE during IET compared with men, especially in the COPD group (ASD -7.42 L/min, P<.001) vs Controls (ASD -1.99, P=.225), with similar ASD in IC and VT between COPD and Controls. Though there were no significant sex differences in baseline dyspnea index score, women had higher Borg dyspnea score during IET for any given VE (ASD=0.55, P=.071 [COPD]; ASD=0.90, P=.001 [Controls]). Scatter plot analysis showed sex separation in dyspnea score at VE >30 L/min in the COPD group, with ASD=0.74; P=.045 in those with VE>30 L/min. ASD in exertional dyspnea reversed when VE was normalized for maximal voluntary ventilation (P=.010 [COPD]; P=.349 [Controls]).
CONCLUSIONS: Women have lower activity levels than men; however ASD in daily physical activity is similar in COPD and Controls. Despite lack of sex differences in baseline dyspnea, women experience higher levels of dyspnea for a given absolute VE during exercise, likely due to their relatively reduced ventilatory capacity. Sex differences in physiological and sensory responses to IET appear similar in both COPD and Controls.
CLINICAL IMPLICATIONS: Underlying differences in activity and ventilatory capacity may impact disease progression in women with COPD through increased dyspnea perception. Interventions (eg, exercise) in those with early stage COPD disease may prevent the downward spiral of dyspnea and exercise avoidance, especially in women.
DISCLOSURE: Richard Casaburi: Consultant fee, speaker bureau, advisory committee, etc.: Boehringer Ingelheim François Maltais: Consultant fee, speaker bureau, advisory committee, etc.: Boehringer Ingelheim, Grant monies (from industry related sources): Boehringer Ingelheim Janos Porszasz: Consultant fee, speaker bureau, advisory committee, etc.: Boehringer Ingelheim Emmanuelle Clerisme-Beaty: Employee: Boehringer Ingelheim Zhenchao Guo: Employee: Boehringer Ingelheim Heather Paden: Employee: Boehringer Ingelheim Denis O'Donnell: Grant monies (from industry related sources): Boehringer Ingelheim, Consultant fee, speaker bureau, advisory committee, etc.: Boehringer Ingelheim The following authors have nothing to disclose: Jordan Guenette
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