A LARGE study from the German Lung Emphysema Registry has revealed notable sex-related differences in how people experience improvement after endoscopic lung volume reduction, a minimally invasive procedure used to help those with advanced chronic obstructive lung disease. While men and women showed almost identical physical improvements, women consistently reported better symptom relief and greater gains in overall wellbeing.
A Closer Look at Who Was Studied
The researchers examined 778 adults treated with valve-based lung volume reduction between 2017 and 2025. Women made up just under half the group. Both sexes were similar in age and body size, although women performed slightly better on breathing tests before treatment. Despite this, women reported feeling worse, scoring higher on questionnaires measuring breathlessness, fatigue and the daily impact of lung disease.
Men, on the other hand, had higher rates of heart-related conditions such as coronary artery disease and irregular heart rhythm.
What Improved After Treatment
Follow-up results from 574 participants showed that both sexes experienced similar physical gains three months after treatment. They improved by similar amounts in how quickly they could breathe out, how much trapped air was removed from the lungs and how efficiently they exchanged oxygen.
Yet meaningful differences appeared when researchers looked at how patients felt. Women reported larger improvements in symptom scores and in measures of daily functioning, energy and quality of life.
Why Women May Fare Better with Lung Volume Reduction
When researchers analysed the data further, they found that being female was an independent predictor of meaningful improvement in quality of life, even after accounting for other factors such as the pattern of emphysema and the size of the physiological response.
These findings raise an important question for future research: should the level of improvement considered “clinically important” be different for men and women? While the biological effects of the treatment may be similar, the lived experience of recovery appears to vary, offering opportunities to better tailor care.
Reference
Atug E et al; German Lung Emphysema Registry Study Group. 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.
