Sex and Gender Differences in Expiratory Central Airway Collapse: A Retrospective Cohort Study

Sex and gender influence the presentation and impact of multiple respiratory disorders, yet their role in expiratory central airway collapse (ECAC) remains poorly understood. To help address this gap, we examined differences in symptom burden, functional status, and quality of life (QOL) between women and men with ECAC.

This single-center retrospective cohort study included adults who underwent dynamic bronchoscopy for suspected ECAC between January 2019 and October 2024. Patients without evidence of ECAC on bronchoscopy were excluded. ECAC severity was quantified using a composite score derived from six airway segments and classified as non-severe or severe. Respiratory symptoms, dyspnea severity (modified Medical Research Council scale), pulmonary function tests, 6-min walk test (6MWT) distance, and health-related QOL (St. George's Respiratory Questionnaire [SGRQ] and Cough-Specific Quality-of-Life Questionnaire [CQLQ]) were compared by sex. Multivariable regression models assessed associations between female sex and patient-centered outcomes, adjusting for age, body mass index, ECAC severity, and comorbidities.

A total of 288 patients with ECAC were included, of whom 195 (67.7%) were women. Anatomic ECAC severity was similar between women and men, with severe ECAC present in 62.6% and 62.4%, respectively (p = 1.00). Pulmonary function was also comparable. Women demonstrated lower median 6MWT distance compared with men (344.8 vs. 366.4 m; p = 0.029). Chronic cough was more prevalent among women (91.8% vs. 79.6%; p = 0.006), and women more frequently reported severe dyspnea. Quality-of-life scores were significantly worse in women, with higher median SGRQ (69.4 vs. 58.2; p = 0.008) and CQLQ scores (78.5 vs. 68.0; p = 0.002). In adjusted analyses, female sex was independently associated with higher SGRQ and CQLQ scores, increased dyspnea severity, and greater cough prevalence.

In this ECAC cohort, women had higher symptom burden, lower functional capacity, and poorer respiratory QOL than men despite comparable anatomic severity. These findings may reflect sex- and gender-related differences in the clinical presentation of ECAC and could inform more individualized diagnostic and management strategies.