{
  "abstract": "Background Endoscopic lung volume reduction (ELVR) is increasingly used for treating patients with chronic obstructive pulmonary disease (COPD) and severe hyperinflation. Data on sex differences in ELVR outcomes are lacking, highlighting the need for detailed analysis.Methods This retrospective analysis examines sex-specific outcomes of ELVR with bronchoscopic valve placement using data from the German Lung Emphysema Registry (January 2017 to January 2025).Results The final analysis included 778 patients, 378 (47.2%) women, mean age 65.9±7.6 years. No significant differences in age or body mass index. At baseline, women had slightly better forced expiratory volume in 1 s (FEV 1)% (31.4±8.5 vs 28.1±8.1, p<0.001) and vital capacity% (63.6±16.9 vs 59.2±14.8, p<0.001), but similar residual volume (RV)%. Men had higher rates of cardiovascular diseases, including coronary artery disease (20.9% vs 11.7%) and atrial fibrillation (7.3% vs 3.5%), p<0.05. Despite this, women reported a higher symptom burden with higher COPD Assessment Test (CAT) scores (25.9±6.1 vs 24.9±6.1, p<0.001), but similar St. George’s Respiratory Questionnaire (SGRQ) scores. Follow-up at 3 months for 574 patients showed no sex differences in ΔFEV1%, ΔRV% or Δdiffusing capacity of the lung for carbon monoxide%. Differences in treatment response were noted for ΔCAT score (−4.3±6.8 vs −1.9±6.1, p<0.001), ΔSGRQ (−13.2±17.3 vs −5.5±12.48, p<0.001), but not for dyspnoea. Multivariable analyses showed female sex (OR 1.89) as an independent predictor for SGRQ response, along with emphysema heterogeneity (OR 1.01) and pulmonary function response (ΔRV, OR 0.73).Conclusions Sex may not influence physiological outcomes but may impact symptom severity and quality of life, raising the question of whether sex should be considered when determining minimal clinically important differences in COPD.",
  "authors": [
    {
      "affiliations": [
        "Pneumology, Asklepios Klinikum Harburg, Hamburg, Germany"
      ],
      "name": "Elvin Atug"
    },
    {
      "affiliations": [
        "Pneumology and Critical Care Medicine, UniversitätsKlinikum Heidelberg, Heidelberg, Germany",
        "Translational Lung Research Center, German Center for Lung Research, Heidelberg, Germany"
      ],
      "name": "Franziska Christina Trudzinski"
    },
    {
      "affiliations": [
        "Department of Pulmonary and Critical Care Medicine, University Hospital of Giessen and Marburg Campus Marburg, Marburg, Germany"
      ],
      "name": "Angélique Holland"
    },
    {
      "affiliations": [
        "Department of Internal Medicine and Respiratory Medicine, Gemeinschaftskrankenhaus Havelhöhe gGmbH, Berlin, Germany"
      ],
      "name": "Christian Grah"
    },
    {
      "affiliations": [
        "Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charité—Universitätsmedizin, Berlin, Germany"
      ],
      "name": "Ralf-Harto Huebner"
    },
    {
      "affiliations": [
        "Pneumology, Lungenklinik Hemer, Hemer, Germany"
      ],
      "name": "Franz Stanzel"
    },
    {
      "affiliations": [
        "Thoracic Surgery, Vivantes Klinikum Neukölln, Berlin, Germany"
      ],
      "name": "Stephan Eggeling"
    },
    {
      "affiliations": [
        "Klinik für Innere Medizin—Pneumologie und Schlafmedizin, DRK Kliniken Berlin Mitte, Berlin, Germany"
      ],
      "name": "Bernd Schmidt"
    },
    {
      "affiliations": [
        "Respiratory Medicine, Evangelische Lungenklinik Berlin, Berlin, Germany"
      ],
      "name": "Sylke Kurz"
    },
    {
      "affiliations": [
        "Department of Internal Medicine, Martin-Luther University Halle-Wittenberg, Halle an der Saale, Germany"
      ],
      "name": "Stephan Eisenmann"
    },
    {
      "affiliations": [
        "Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany"
      ],
      "name": "Joanna Krist"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, Allergology and Sleep Medicine, Klinikum Nuremberg, Nuremberg, Germany"
      ],
      "name": "Joachim Ficker"
    },
    {
      "affiliations": [
        "Pneumology, Lungenfachklinik Immenhausen, Immenhausen, Germany"
      ],
      "name": "Björn Wiesemann"
    },
    {
      "affiliations": [
        "Klinik für Pneumologie, Asklepios Fachkliniken München Gauting, Comprehensive Pneumology Center, Gauting, Germany"
      ],
      "name": "Wolfgang Gesierich"
    },
    {
      "affiliations": [
        "Pneumology and Critical Care Medicine, Asklepios Klinik Barmbek, Hamburg, Germany"
      ],
      "name": "Ralf Eberhardt"
    },
    {
      "affiliations": [],
      "name": "on behalf of German Lung Emphysema Registry Study Group"
    }
  ],
  "title": "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.)",
  "uid": "3c7b8884-247e-5afb-a8f3-459d706fcb49"
}