Baseline Differences in ELVR Candidates
ENDOSCOPIC lung volume reduction (ELVR) is increasingly used in chronic obstructive pulmonary disease (COPD) with severe hyperinflation, yet sex specific outcome data have been limited. A retrospective analysis from the German Lung Emphysema Registry evaluated outcomes after ELVR 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, ELVR 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 ELVR, 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.
