Gender-specific aspects of alpha-1-antitrypsin deficiency in relation to lung and liver disease, symptom burden and exacerbations: Data from the EARCO registry

<bold>Background:</bold> Gender affects many aspects of chronic obstructive pulmonary disease (COPD). Limited data are available on gender issues in alpha-1 antitrypsin deficiency (AATD). We investigated gender issues in the EARCO registry, a prospective observational cohort study. <bold>Methods:</bold> Baseline data from PiZZ individuals, enrolled in the registry with complete data on sex and smoking history were analysed by group comparisons and binary logistic regression analyses. <bold>Results:</bold> 1283 patients with AATD, 633 females were analysed. Females were older than males (56.7±13.6 vs. 54.3±14.2y p=0.002), reported less tobacco consumption (16.8±12.2 vs. 19.6±14.5 PY p=0.006) and consumed less alcohol (5.5±7.6 vs. 8.4±10.3 u/week p<0.001). Accordingly, females reported less often COPD (41% vs. 57%; p<0.001) and liver disease (11% vs. 20% p<0.001). However, they had a higher prevalence of bronchiectasis (24% vs. 13% p<0.001). Despite better lung function (FEV1%pred. 69.2±28.5 vs. 58.2±27.0 p<0.001) females reported a similar symptom burden (CAT 13.4±9.5 vs. 12.5±8.9 p=ns) and exacerbation frequency ≥1 in the last year (30% vs. 26% p=ns) compared to males. In multivariate analyses, female gender was an independent risk factor for exacerbations OR 1.57 p=0.001 in addition to smoking history, COPD, asthma and bronchiectasis and was also identified as risk factor for symptom burden (CAT≥10) OR 1.43 p=0.013 besides age, BMI, COPD and smoking history. <bold>Conclusion:</bold> Men had higher rates of COPD and liver disease, women were more likely to have bronchiectasis. Women's higher symptom burden and exacerbation frequency suggest they may need tailored treatment approaches.