Responsiveness to Ipratropium Bromide in Male and Female Patients with Mild to Moderate Chronic Obstructive Pulmonary Disease

Abstract Introduction Although the prevalence of chronic obstructive pulmonary disease (COPD) is similar between men and women, current evidence used to support bronchodilator therapy has been generated in therapeutic trials that have predominately enrolled male patients. Here, we determined whether there is any significant sex-related differences in FEV 1 responses to ipratropium bromide. Methods Data from the Lung Health Study (n=5887; 37% females) were used to determine changes in FEV 1 with ipratropium or placebo in male and female subjects with mild to moderate COPD over 5years. Lung Expression Quantitative Trait Loci (eQTL) dataset was used to determine whether there were any sex-related differences in gene expression for muscarinic (M2 and M3) receptors in lungs of male and female patients. Results After 4months, ipratropium therapy increased FEV 1 by 6.0% in female and 2.9% in male subjects from baseline values (p=2.42×10 −16 ). This effect was modified by body mass index (BMI) such that the biggest improvements in FEV 1 with ipratropium were observed in thin female subjects (p for BMI∗sex interaction=0.044). The sex-related changes in FEV 1 related to ipratropium persisted for 2years (p=0.0134). Female compared with male lungs had greater gene expression for M3 relative to M2 receptors (p=6.86×10 −8 ). Conclusion Ipratropium induces a larger bronchodilator response in female than in male patients and the benefits are particularly notable in non-obese females. Female lungs have greater gene expression for the M3 muscarinic receptor relative to M2 receptors than male lungs. Female patients are thus more likely to benefit from ipratropium than male COPD patients.