Sex differences in asthma and COPD hospital admission, readmission and mortality

Background Asthma and chronic obstructive pulmonary disease (COPD) outcomes vary by sex. We investigated whether males and females with asthma or COPD are managed differently in-hospital when admitted for an exacerbation. Methods Data from the National Asthma and COPD Audit Programme were used to determine three cohorts of people hospitalised for an exacerbation: (1) adults with asthma, (2) children and young people (CYP) with asthma, and (3) adults with COPD. Outcomes included the following in-hospital interventional measures: spirometry recording, respiratory specialist review, respiratory medication administration and discharge bundle recording. Linked hospital data were used to determine 30-day and 90-day readmissions and Office for National Statistics data for 90-day mortality. Random effects logistic regression was used to investigate the association between sex and in-hospital outcomes, readmission and mortality. Results 16 370 adults with asthma, 7156 CYP with asthma and 28 354 adults with COPD were included. Female adults with asthma had higher odds of being seen by a respiratory specialist ( a OR 0.1.13, 1.02-1.26) and higher odds of readmission within 30 and 90 days ( a OR 1.22, 1.10–1.37, a OR 1.34, 1.23–1.46) compared with males. Female adults with COPD had higher odds of being seen by a respiratory specialist, ( a OR 1.10,1.02–1.19), being administered non-invasive ventilation ( a OR 1.18, 1.09–1.29), and receiving a discharge bundle ( a OR 1.07, 1.00–1.14), and lower odds of readmission within 90 days ( a OR 0.95, 0.90–1.01), or mortality within 90 days ( a OR 0.88, 0.81–0.96). Lastly, female CYP had higher odds of steroids administered within 1 hour ( a OR 1.13, 1.00–1.28) and higher 30-day and 90-day readmission compared with males ( a OR 1.21, 1.00–1.44 and 1.17, 1.03–1.34). Interpretation Sex differences in in-hospital care exist in adults COPD, which may impact readmissions and mortality; however, little to no sex differences in in-hospital care were seen in people with asthma yet females were more likely to be readmitted to hospital.