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Researchers found significant sex-based differences in ILD in patients with interdisciplinary indications for complete diagnostic workups involving lung biopsy.

Significant sex-based differences exist in the prevalence and characteristics of interstitial lung disease (ILD) in patients with an interdisciplinary indication for a complete diagnostic workup that includes lung biopsy, according to a study published online in Scientific Reports.

“Notably, idiopathic pulmonary fibrosis (IPF) emerged as the most prevalent diagnosis among men, while hypersensitivity pneumonitis was more frequently diagnosed in women,” wrote corresponding author Franziska C. Trudzinski, MD, of Thoraxklinik University of Heidelberg, Heidelberg, Germany, and study coauthors. “Additionally, men were more likely to be diagnosed with unclassifiable interstitial lung disease compared to women,”

Analysis & Results

The researchers conducted a retrospective case analysis of 402 patients with suspected ILD—145 women and 248 men—who received an interdisciplinary indication for lung biopsy and underwent bronchoalveolar lavage, transbronchial cryobiopsy (TCB) and, if necessary, surgical lung biopsy between November 2017 and December 2021. Medical histories, comorbidities, imaging, and final diagnoses were investigated.

Men and women reported similar smoking behavior, according to the study, but women reported more environmental exposures while men reported more occupational exposures.

Rates of thyroid disease and extrathoracic malignancies were higher in women than men (29.9% vs 12.5% and 16.2% vs 9.3%, respectively). However, women had lower rates of coronary heart disease (7.1% vs 19.8%), stroke (1.3% vs 6.5%), and sleep apnea (5.8% vs 17.7%) than men.

Lung density did not differ between women and men, but visual assessment of computed tomography revealed lower rates of reticular opacities (65% vs 76%) and features of usual interstitial pneumonia (17% vs 34%) in women.

The study found that hypersensitivity pneumonitis was the final diagnosis for 34.4% of women compared with 21.8% of men. IPF was the final diagnosis for 22.6% of men compared with 7.1% of women, and unclassifiable interstitial lung disease was the final diagnosis for 21.8% of men compared with 6.5% of women.

Sex-Based Factors in ILD Diagnosis & Management

“These findings underscore the importance of considering sex-specific factors in the diagnosis and management of ILD,” the researchers concluded. “Overall, it is possible that men and women may require different therapeutic approaches.”