Absolute values of lung function explain the sex difference in breathlessness in the general population.

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Abstract

Activity-related breathlessness is twice as common among females as males in the general population and is associated with adverse health outcomes. We tested whether this sex difference is explained by the lower absolute forced expiratory volume in 1 s (FEV1) or forced vital capacity (FVC) in females.This was a cross-sectional analysis of 3250 subjects (51% female) aged 38-67 years across 13 countries in the population-based third European Community Respiratory Health Survey. Activity-related breathlessness was measured using the modified Medical Research Council (mMRC) scale. Associations with mMRC were analysed using ordered logistic regression clustering on centre, adjusting for post-bronchodilator spirometry, body mass index, pack-years smoking, cardiopulmonary diseases, depression and level of exercise.Activity-related breathlessness (mMRC ≥1) was twice as common in females (27%) as in males (14%) (odds ratio (OR) 2.21, 95% CI 1.79-2.72). The sex difference was not reduced when controlling for FEV1 % predicted (OR 2.33), but disappeared when controlling for absolute FEV1 (OR 0.89, 95% CI 0.69-1.14). Absolute FEV1 explained 98-100% of the sex difference adjusting for confounders. The effect was similar within males and females, when using FVC instead of FEV1 and in healthy never-smokers.The markedly more severe activity-related breathlessness among females in the general population is explained by their smaller spirometric lung volumes.

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Author and article information

Journal

Journal ID (iso-abbrev): Eur. Respir. J.

Title: The European respiratory journal

Publisher: European Respiratory Society (ERS)

ISSN (Electronic): 1399-3003

ISSN (Print): 0903-1936

Publication date (Electronic): May 2017

Volume: 49

Issue: 5

Affiliations

[1 ] Dept of Respiratory Medicine and Allergology, Institution for Clinical Sciences, Lund University, Lund, Sweden pmekstrom@gmail.com.

[2 ] Section of Occupational and Environmental Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

[3 ] Dept of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.

[4 ] Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.

[5 ] Centre for International Health, University of Bergen, Bergen, Norway.

[6 ] Dept of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.

[7 ] Inserm, UMR 1152, Pathophysiology and Epidemiology of Respiratory Diseases, Paris, France.

[8 ] Respiratory Epidemiology and Public Health Group, Imperial College London, National Heart and Lung Institute, London, UK.

[9 ] Dept of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland.

[10 ] Faculty of Medicine, University of Iceland, Reykjavik, Iceland.

[11 ] Département de Pneumologie et Addictologie, University Hospital of Montpellier, Montpellier, France.

[12 ] Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.

[13 ] Pédiatrie, Pôle Couple Enfants, CHU de Grenoble Alpes, Grenoble, France.

[14 ] INSERM U 1209, Grenoble, France.

[15 ] Université Grenoble Alpes, Grenoble, France.

[16 ] Division of Respiratory Diseases, Dept of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy.

[17 ] Division of Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.

[18 ] Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany.

[19 ] Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Inner City Clinic, University Hospital Munich, Ludwig-Maximilians-Universität of Munich, German Center for Lung Research, Munich, Germany.

[20 ] INSERM U897, Institute of Public Health and Epidemiology, Bordeaux University, Bordeaux, France.

[21 ] Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Australia.

[22 ] Dept of Public Health and Paediatrics, University of Turin, Turin, Italy.

[23 ] Dept of Respiratory Medicine, Galdakao Hospital, Bizkaia, Spain.

[24 ] Unit of Pneumology, University Hospital of Albacete, Albacete, Spain.

[25 ] Dept of Nursing, University of Huelva, Huelva, Spain.

[26 ] Dept of Medical Sciences, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.

[27 ] Both authors contributed equally.

Article

Publisher Item ID: 49/5/1602047

DOI: 10.1183/13993003.02047-2016

PubMed ID: 28546280

SO-VID: 878146e2-8d9b-472f-aa0f-a97cea946852

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