Sex-Differences in Alpha-1 Antitrypsin Deficiency: Data From the EARCO Registry

Ersöz, Hilal; Torres-Durán, María; Turner, Alice M.; Tanash, Hanan; Rodríguez García, Carlota; Corsico, Angelo Guido; López-Campos, José Luis; Miravitlles, Marc; Clarenbach, Christian F.; Chapman, Kenneth R.; Hernández Pérez, José M.; Guimarães, Catarina; Bartošovská, Eva; Greulich, Timm; Barrecheguren, Miriam; Koczulla, Andreas Rembert; Höger, Philipp; Olivares Rivera, Arturo; Herth, Felix; Trudzinski, Franziska C.

doi:10.1016/j.arbres.2024.06.019

Archivos de Bronconeumología

ISSN: 0300-2896

Archivos de Bronconeumologia is an international journal that publishes original studies whose content is based upon results of research initiatives dealing with several aspects of respiratory medicine including epidemiology, respiratory physiology, pathophysiology of respiratory diseases, clinical management, thoracic surgery, pediatric lung diseases, respiratory critical care, respiratory allergy and translational research. Other types of articles such as editorials, reviews, and different types of letters are also published in the journal. Additionally, the journal expresses the voice of the following scientific societies: the Spanish Respiratory Society of Pneumology and Thoracic Surgery (SEPAR; https://www.separ.es/), the Latin American Thoracic Society (ALAT; https://alatorax.org/), and the Iberian American Association of Thoracic Surgery (AIACT; http://www.aiatorax.com/).

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Vol. 61. Issue 1.

Pages 22-30 (January 2025)

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Vol. 61. Issue 1.

Pages 22-30 (January 2025)

Original Article

DOI: 10.1016/j.arbres.2024.06.019

Sex-Differences in Alpha-1 Antitrypsin Deficiency: Data From the EARCO Registry

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Hilal Ersöza,bMaría Torres-Duránc,dAlice M. Turnere,fHanan TanashgCarlota Rodríguez Garcíah,iAngelo Guido Corsicoj,kJosé Luis López-Camposl,dMarc MiravitllesmChristian F. Clarenbacho,pKenneth R. ChapmanqJosé M. Hernández PérezrCatarina GuimarãessEva BartošovskátTimm GreulichuMiriam BarrechegurenmAndreas Rembert Koczullav,wPhilipp Högera,bArturo Olivares Riveraa,bFelix Hertha,bFranziska C. Trudzinskia,b,

Corresponding author

franziska.trudzinski@med.uni-heidelberg.de

Corresponding author.

for the EARCO study investigators ◊

a Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Heidelberg, Germany

b Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research (DZL), Heidelberg, Germany

c Pneumology Service Hospital Alvaro Cunqueiro, Vigo, Institute for Health Research Galicia Sur (IISGS), Vigo, Spain

d Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain

e Institute for Applied Health Research, University of Birmingham, Birmingham B15 2TT, United Kingdom

f University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom

g Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Malmö, Sweden

h Department of Pulmonology, Hospital Clínico-Universitario de Santiago, Santiago de Compostela, Spain

i Interdisciplinary Research Group in Pulmonology, Institute of Health Research of Santiago de Compostela (IDIS), Santiago de Compostela, Spain

j Department of Internal Medicine and Therapeutics, University of Pavia, Italy

k Respiratory Diseases Division, IRCCS Policlinico San Matteo Foundation, Pavia, Italy

l Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Spain

m Pneumology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus – Health Care Provider of the European Reference Network on Rare Respiratory Diseases (ERN LUNG), Barcelona, Spain

o Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland

p Faculty of Medicine, University of Zurich, Zurich, Switzerland

q University of Toronto, Toronto, Canada

r Pneumology Department, Hospital Universitario Nuestra Señora de La Candelaria, Santa Cruz de Tenerife, Spain

s Pulmonology Department,Hospital Senhora da Oliveira, Guimarães, Portugal

t Thomayer hospital, Charles University, Prague, Czech Republic

u University Medical Centre Giessen and Marburg, Philipps-University, Deparment of Medicine, Pulmonary and Critical Care Medicine, Member of the German Centre for Lung Research (DZL), Marburg, Germany

v Pneumologische Rehabilitation, Deutsches Zentrum für Lungenforschung, Philipps-Universität Marburg, Marburg, Germany

w Schön Klinik Berchtesgadener, PMU Salzburg, Austria

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Tables (4)

Table 1. Demographics and exposure stratified for sex.

Table 2. Functional diagnostics, symptoms and disease-specific and medical contacts stratified for sex.

Table 3. COPD subgroup, pulmonary function, symptoms and disease-specific and medical contacts.

Table 4. Independent predictors of symptoms and exacerbations Shown are the results of the logistic regression analyses for the outcomes; symptom burden, mMRC ≥2 and CAT ≥10 as well as axacerbations ≥1 in the previous year.

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Abstract

Background

Sex and gender influence many aspects of chronic obstructive pulmonary disease (COPD). Limited data are available on this topic in alpha-1 antitrypsin deficiency (AATD). We therefore aimed to investigate sex issues in the EARCO registry, a prospective, international, observational cohort study.

Methods

Baseline data from PiZZ individuals, enrolled in the registry with complete data on sex and smoking history were analysed by group comparisons and binary logistic regression analyses.

Results

1283 patients with AATD, 49.3% women were analysed. Females reported less tobacco consumption (16.8±12.2 vs. 19.6±14.5 PY, p=0.006), occupational exposures towards gases, dusts or asbestos (p<0.005 each) and consumed less alcohol (5.5±7.6 vs. 8.4±10.3u/week, p<0.001). Females reported COPD (41% vs. 57%, p<0.001) and liver disease (11% vs. 20%, p<0.001) less often. However, they had a higher prevalence of bronchiectasis (24% vs. 13%, p<0.001). Despite better lung function (FEV1%pred. 73.6±29.9 vs. 62.7±29.5, p<0.001) females reported a similar symptom burden (CAT 13.4±9.5 vs. 12.5±8.9, p=ns) and exacerbation frequency (at least one in the previous year 30% vs. 26%, p=ns) compared to males. In multivariate analyses, female sex was an independent risk factor for exacerbations in the previous year OR 1.6 p=0.001 in addition to smoking history, COPD, asthma and bronchiectasis and was also identified as risk factors for symptom burden (CAT≥10) OR 1.4 p=0.014 besides age, BMI, COPD and smoking history.

Conclusion

Men had higher rates of COPD and liver disease, women were more likely to have bronchiectasis. Women's higher symptom burden and exacerbation frequency suggest they may need tailored treatment approaches.

Keywords:

Chronic obstructive pulmonary disease

Gender

Alpha1-antitrypsin

Alpha1-antitrypsin deficiency