Key result
Among COPD patients receiving long-acting bronchodilators, women had a lower risk of moderate-to-severe exacerbations than men.
Why the study?
Conflicting findings exist on whether women with COPD have higher exacerbation risk than men, and prior studies did not consider the impact of mainstay treatments.
Do women have a different risk of moderate-to-severe exacerbations compared to men among COPD patients treated with long-acting bronchodilators?
Cohort (n=140,216)
Yes
Do women have a different risk of moderate-to-severe exacerbations compared to men among COPD patients treated with long-acting bronchodilators?
Among Asian patients with COPD receiving long-acting bronchodilators, women have a significantly lower risk of moderate-to-severe exacerbations compared to men.
Answers are grounded in this paper and cite their sources.
Suggests sex-specific risk stratification may be necessary in treated COPD; leaves open whether targeted.
INTRODUCTION: Several post hoc analyses of clinical trials and observational studies have noticed that women may be at a higher risk of exacerbations than men among patients with chronic obstructive pulmonary disease (COPD), although the findings remain conflicting. These studies, however, did not consider the impact of mainstay treatments over longitudinal follow-up. We examined whether the risk of acute exacerbations differed between women and men in patients with COPD treated with long-acting bronchodilators. METHODS: This population-based study included 2 cohorts of patients with COPD who initiated a single long-acting bronchodilator (mono-bronchodilator cohort) or a dual combination of long-acting bronchodilators (dual-bronchodilator cohort) identified from a nationwide Taiwanese claims database (2017-2022). In each cohort, Cox regression models were executed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of moderate-to-severe exacerbations comparing women to men after 1:10 variable-ratio propensity score (PS) matching. RESULTS: There were 51,945 patients (9,643 women and 42,302 men) in the mono-bronchodilator cohort and 88,271 patients (15,418 women and 72,853 men) in the dual-bronchodilator cohort after PS matching. The HR of moderate-to-severe exacerbations comparing women to men was 0.86 (95% CI, 0.80-0.92) and 0.88 (95% CI, 0.84-0.92) for each cohort, respectively. Results were consistent when analyzing moderate and severe exacerbations separately and did not change materially across prespecified subgroup and sensitivity analyses. CONCLUSION: The present study including two sizable COPD cohorts of Asian patients suggests that women may have a lower risk of exacerbations than men when regularly receiving long-acting bronchodilators. The findings highlight the importance of considering maintenance treatments when evaluating sex differences in the risk of acute exacerbations.
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Lu et al. (2026) conducted a cohort in Chronic Obstructive Pulmonary Disease (COPD) (n=140,216). Female sex vs. Male sex was evaluated on moderate-to-severe exacerbations (HR 0.86, 95% CI 0.80-0.92). Among COPD patients receiving long-acting bronchodilators, women had a lower risk of moderate-to-severe exacerbations than men.
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