Sex differences in exertional dyspnea in patients with mild COPD: Physiological mechanisms

The purpose of this study was to evaluate the physiological basis for sex-differences in exercise-induced dyspnea in patients with mild COPD. We compared operating lung volumes, breathing pattern and dyspnea during incremental cycling in 32 men (FEV1 = 86 ± 10% predicted) and women (FEV1 = 86 ± 12% predicted) with mild COPD and 32 age-matched controls. There were no sex differences in dyspnea in the control group at any work-rate or ventilation (V˙E). Women with COPD had significantly greater dyspnea than men at 60 and 80 W. At 80 W, dyspnea ratings were 5.7 ± 2.3 and 3.3 ± 2.5 Borg units (P < 0.05) and the V˙E to maximal ventilatory capacity ratio was 72% and 55% in women and men, respectively (P < 0.05). Comparable increases in dynamic hyperinflation were seen in both male and female COPD groups at symptom limitation but women reached tidal volume constraints at a lower work rate and V˙E than men. Superimposing mild COPD on the normal aging effects had greater sensory consequences in women because of their naturally reduced ventilatory reserve.