 from researchers at Sweden’s Lund University is among the first to show that women may be at much greater risk of developing chronic obstructive pulmonary disease than men—perhaps as much as 50% more likely.

For a condition that affects as many patients as does COPD, with a high mortality rate, it is surprising that such a potentially strong correlation between female sex and disease susceptibility hasn’t been definitively made previously. While a few earlier studies did show a potential sex effect, the clinical evidence has been conflicting in some cases, and many of the studies before this one looked only at younger patients and more strongly at the clear correlation between smokers and non-smokers. “With regard to sex as a risk factor for developing COPD, the evidence is not clear-cut and seems to depend on the diagnostic criteria used,” the researchers note.

The current research incorporates a new modern measurement for defining airflow limitation in COPD: Lower Limit of Normal (LLN), which has recently been recommended by the American Thoracic Society and the European Respiratory Society, among others. The results of the study suggest that women’s airways may be more sensitive than men’s. Previous COPD measurement was done with spirometry.

“Other potential mechanisms behind the sex effect may include effects of sex hormones

 susceptibility due to dimensional differences, and morphological differences suggesting a difference in the natural history of COPD,” the authors suggest

The finding will need to be confirmed by further research. Limitations of the study include that it included only post-menopausal females; thus, the results may not translate to younger females

 “The observed sex effect could theoretically be affected by higher awareness of COPD in male patients, leading to better treatment and spirometry performance,” the authors noted. “With few incident subjects, the observed effect may possibly be an artefact of natural variability, measurement error and dichotomizing a continuous outcome to either obstructive or non-obstructive.”

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Researchers suggest that women may be at much greater risk of developing chronic obstructive pulmonary disease than menâ€”perhaps as much as 50% more likely.

Women May Be Twice as Likely to Develop COPD

 suggests that computer programs that use what’s called computer-adapted testing—or CAT&mdash;may be significantly more likely to lead to better outcomes patients who are at risk for skin cancer.

The finding is potentially important because online surveying and screening of patients with skin cancer is an emerging and important field, but it can be hindered by participation rates. Removing some of the obstacles to participation could be a significant boon to overall screening efforts.

The study is from Australia, a country with an incredibly high incidence of skin cancers. In the land down under, skin cancers account for approximately 80% of all newly diagnosed cancers. “From a population of only 23 million, more than 434,000 people are treated for one or more nonmelanoma skin cancers in Australia each year,” the study authors observe.

The researchers have been working with questionnaires that assess the underlying risk of potential cancer patients. The researchers posited that using responses to questions about attitudes toward sunblock usage, indoor and outdoor tanning, body freckles, eye color, and tendency to burn, among other questions, it should be possible to create a scale to measure these attributes and calculate an overall skin cancer risk score.

They compared the efficiency of non-adaptive (NAT) and CAT facilitated by Partial Credit Model (PCM)-derived calibration to estimate skin cancer risk, using a random sample from a population-based Australian cohort study of skin cancer risk (N=43,794). Using statistical models, including popular Rasch models, they found that use of CAT led to smaller person standard error of the estimated measure than NAT, with substantially higher efficiency but no loss of precision. The CAT test reduced response burden by 48%, 66%, and 66% for dichotomous, Rating Scale Model, and PCM models, respectively.

“A brief CAT such as the one we developed could be used to inform people quickly about their skin cancer risk and how to improve their sun protection behaviors,” the researchers concluded. “A mobile online CAT could be used for evaluating skin cancer risk and might reduce the item length in clinical settings.”

Strengths of the study include a very large sample size. Possible limitations include possible need to modify the CAT module for non-English speaking populations.

May 2016

Women May Be Twice as Likely to Develop COPD

Computerized Patient Survey Can Aid in Skin Cancer Screening