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Respiratory physicians placing too much emphasis on gender when diagnosing IPF 


Respiratory physicians place too much emphasis on gender when diagnosing idiopathic pulmonary fibrosis (IPF), leading to overdiagnosis in men and underdiagnosis in women,  international research reveals.

To investigate whether biases pertaining to biological sex exist in establishing a diagnosis of ILD, researchers from the UK and Canada asked 404 respiratory physicians from 706 countries to review 60 consecutive cases of ILD seen at the Royal Brompton and Harefield NHS Foundation Trust in 2010, before the antifibrotic era.

They found that the odds of a male patient receiving a diagnosis of IPF were three times that of a female patient, after adjusting for age, smoking history, environmental or occupational exposures, and presence of autoantibodies or serum precipitins (OR=3.05, 95% CI: 2.81 to 3.31).

Men also had a significantly greater adjusted odds of receiving a leading diagnosis of IPF compared with women when their CT scan showed probable UIP (OR=1.74, 95% CI: 1.52 to 2.01), was of indeterminate pattern (OR=4.83, 95% CI: 3.54 to 6.59) or compatible with an alternate diagnosis (OR=25.58, 95% CI: 17.80 to 36.77).

According to the researchers, their results show that respiratory physicians placed great emphasis on patient gender in making a clinical diagnosis of IPF, especially in cases where the CT scan was not definitive for a UIP pattern.

“Overall, female patients are likely to be underdiagnosed with IPF, whereas male patients are overdiagnosed with IPF,” they concluded in their study published in Thorax.

“Gender-based biases in the diagnosis of IPF may have a detrimental impact on treatment initiation. In studies of antifibrotic therapy, male patients comprise the majority of participants. Including a lower proportion of female patients in drug studies may lead to underappreciating the effects and risks of these medications in women. Female patients have also been shown to discontinue treatment more frequently, which could suggest that physicians feel less compelled to keep patients on medication when the diagnosis is less certain.”

“The ILD research and clinical community need to carefully ensure that female patients with IPF are diagnosed and managed appropriately. Moreover, IPF treatment trials should ensure that enrolled cohorts accurately reflect the proportions of male and female patients with IPF in unselected populations,” they added.

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