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Sex differences in physiological progression of idiopathic pulmonary fibrosis

¹ University of Michigan Health System, Ann Arbor, MI, ³ Mayo Clinic, Scottsdale, AZ, ⁴ Memorial Sloan Kettering Cancer Center, New York, NY, USA, ² University of Calgary, Calgary, AB, Canada.

CORRESPONDENCE: M. K. Han, 1500 E Medical Center Drive, 3916 Taubman Center, Ann Arbor, MI 48109-0360, USA, Fax: 1 7349365048. E-mail: mrking{at}umich.edu

Keywords: Desaturation, interstitial lung disease, 6-min walk test, survival

Received: December 6, 2007
Accepted February 13, 2008

In idiopathic pulmonary fibrosis, incidence is higher in males, and females may have better survival. The aim of the present study was to determine whether the rate of increase in desaturation during serial 6-min walk testing would be greater, and survival worse, for males versus females.

Serial changes in the percentage of maximum desaturation area (DA) over 1 yr were estimated using mixed models in 215 patients. DA was defined as the total area above the curve created using desaturation percentage values observed during each minute of the 6-min walk test. Multivariate Cox regression assessed survival differences.

Adjusting for baseline DA, 6-min walk distance, change in 6-min walk distance over time and smoking history, the percentage of maximum DA increased by an average of 2.83 and 1.37% per month for males and females, respectively. Females demonstrated better survival overall, which was more pronounced in patients who did not desaturate below 88% on ambulation at baseline and after additionally adjusting for 6-month relative changes in DA and forced vital capacity.

These data suggest that differences in disease progression contribute to, but do not completely explain, better survival of females with idiopathic pulmonary fibrosis.