The Role of Gender Regarding the Outcomes of Pulmonary Rehabilitation in Patients with COPD: A Retrospective Study

Year 2023, Volume: 7 Issue: 1, 35 - 42, 31.01.2023

Yelda Varol , Hülya Şahin İlknur Naz Gürşan , Berna Kömürcüoğlu

https://doi.org/10.30621/jbachs.1031419

Abstract

PURPOSE: Our aim is to compare the pulmonary rehabilitation outcomes of male and female patients diagnosed with COPD.
METHODS: Outpatient PR program, consisting of 16 sessions, two times a week for two months was applied to the patients with COPD (41 males, 41 females). arterial blood gas (ABG) analyzes and pulmonary function tests (PFT), 6-minute walking test (6MWT), dyspnea scale (mMRC), health-related quality of life (QoL) questionnaire (SF-36), disease-specific health status (SGRQ) were applied to all participants before and after PR.
RESULTS: There was no statistically significant differences between the two groups before PR in terms of age, BMI, PFT parameters, and ABG results. Cigarette consumption was higher in men(p=0.02). Quality of life survey results (SGRQ, SF36), HAD anxiety, mMRC were similar in both groups before PR(p>0.05 for all).After PR, both clinical and statistically significant improvements were detected in 6mWD in both groups (p <0.001 for both). There was a significant improvement in all SGRQ scores in both genders (p<0.05 for all). While significant improvement was observed in all parameters of SF36 in women, significant improvement was found in only some parameters of SF36 in male patients. While HAD anxiety and depression scores significantly improved in female patients after PR, only anxiety score in male patients improved (p=0.004, p=0.002, p=0.021).
CONCLUSION: This study showed that PR has had a positive effect on many outcome measures, regardless of gender. After PR; The walking distance and QoL scores increased, perception of dyspnea, anxiety and depression score decreased in women with COPD.

Keywords

COPD, pulmonary rehabilitation, gender, COPD, pulmonary rehabilitation, gender

Project Number

(49109414-806. 02/02/2017).

References

• References 1. Gold 2020 Report; Global Strategy for The Diagnosis, Management, And Prevention of COPD page:16, Rehabilitation, Education & Self-Management part page:57.
• 2. Han MK, Postma D, Mannino DM, et al. Gender and chronic obstructive pulmonary disease: why it matters. Am J Respir Crit Care Med 2007;176:1179-84.
• 3. Aryal S, Diaz-Guzman E, Mannino DM. COPD and Gender Differences: An Update. TranslRes 2013;162:208-18.
• 4. Chapman KR. Chronic obstructive pulmonary disease: are women more susceptible than men? Clin Chest Med 2004;25:331-41.
• 5. Dransfield MT, Washko GR, Foreman MG, et al. Gender differences in the severity of CT emphysema in COPD. Chest 2007;132:464-70.
• 6. Miller MR, Jordan RE, Adab P. Gender differences in COPD: are women more susceptible to smoking effects than men? Thorax 2011;66:921-2.
• 7. Nguyen LP, Beck E, Cayetano K, et al. Differential Pulmonary Rehabilitation Outcomes in Patients with and without COPD: Role of Gender. J Cardiopulm Rehabil Prev 2017;37:350-5.
• 8. Sahin H, Varol Y, Naz I, et al. Effectiveness of pulmonary rehabilitation in COPD patients receiving long-term oxygen therapy. Clin Respir J 2018;12:1439-46.
• 9. Varol Y, Şahin H, Aktürk Ü, et al. Effect of Pulmonary Rehabilitation on the Value of the Inspiratory Capacity-to-Total Lung Capacity (IC/TLC) Ratio to Determine Response to Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease. Turk Thorac J 2019;20:224-9.
• 10. Miller MR, Crapo R, Hankinson J, Burgos F, Casaburi R, Coates A, et al; ATS/ERS task force. General considerations for lung function testing. Eur Respir J 2005;26:153-161.
• 11. Sweer L and Zwillich CW. Dyspnea in the patient with chronic obstructive pulmonary disease. Etiology and management. Clin Chest Med 1990;11:417-45.
• 12. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166: 111-7.
• 13. Polatlı M, Yorgancıoglu A, Aydemir O, et al. Validity and reliability of Turkish version of St. George’s respiratory questionnaire. Tuberk Toraks 2013;61:8187.
• 14. Kocyigit H, Aydemir O, Fisek G, et al. Validity and reliability of Turkish version of Short Form SF-36. Turkish J Drugs Therapeutics 1999;12:102-6.
• 15. Enright PL, Sherrill, DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 1998;158:1384-7.
• 16. Halbert RJ, Natoli JL, Gano A, et al. Global burden of COPD: systematic review and meta-analysis. Eur Respir J 2006;28:523-52.
• 17. Cote CG, Chapman KR. Diagnosis and treatment considerations for women with COPD. Int J Clin Pract 2009;63:486-93.
• 18. de Torres JP, Casanova C, Hernandez C, et al. Gender associated differences in determinants of quality of life in patients with COPD: a case series study. Health Qual Life Outcomes 2006;4:72.
• 19. Lieberman L, Meana M, Stewart D. Cardiac rehabilitation: gen- der differences in factors influencing participation. J Womens Health 1998;7:717-23.
• 20. Paolucci S, Bragoni M, Coiro P, et al. Is sex a prognostic factor in stroke rehabilitation? Stroke 2006;37:2989-94.
• 21. Robles PG, Brooks D, Goldstein R, et al. Gender-Associated Differences in Pulmonary Rehabilitation Outcomes in People with Chronic Obstructive Pulmonary Disease. J Cardiopulm Rehabil Prev 2014;34:87-97.
• 22. Haggerty MC, Stockdale-Woolley R, ZuWallack R. Functional status in pulmonary rehabilitation participants. J Cardiopulm Rehabil Prev 1999;19:35-42.
• 23. Skumlien S, Skogedal EA, Bjortuft O, et al. Four weeks’ intensive rehabilitation generates significant health effects in COPD patients. Chron Respir Dis 2007;4:5-13.
• 24. Ninot G, Fortes M, Poulain M, et al. Gender difference in coping strategies among patients enrolled in an inpatient rehabilitation program. Heart Lung 2006;35:130-136.
• 25. DeMeo DL, Ramagopalan S, Kavati A, et al; COPD Gene Investigators. Women manifest more severe COPD symptoms across the life course. Int J Chron Obstruct Pulmon Dis 2018;13:3021-9.
• 26. Celli B, Vestbo J, Jenkins CR, et al. Sex differences in mortality and clinical expressions of patients with chronic obstructive pulmonary disease. The TORCH experience. Am J Respir Crit Care Med 2011;183:317-22.
• 27. Özdemir T, Candemir I, Ergün P, et al . Patients with COPD who underwent pulmonary rehabilitation in Turkey: prevalence, distribution, and mortality. Turk J Med Sci 2020;50:141-7.