Younger Women More Severely Affected by COPD Disease Burden, Study Finds

Recent research indicates that there are age-associated gender differences seen in the disease burden of chronic obstructive pulmonary disorder (COPD), with younger women more severely affected.

A study involving 4484 individuals with COPD demonstrated that younger women were more likely than younger men to exhibit severe dyspnea, more severe airflow limitation, were at greater risk for exacerbations, and had more severe disease classification according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines.

These gender associations were less pronounced among adults 65 years or older, particularly in regards to dyspnea, airflow limitations, and GOLD classification. However, older women with COPD were still more likely to experience dyspnea and present with more severe COPD than older men.

The results suggest that women are more significantly burdened by the symptoms of COPD than men and that younger women may be particularly susceptible. COPD, the third-leading cause of death in the United States, has traditionally been viewed as a male disease. But prevalence and mortality are on the rise in women. This has been attributed to increasing rates of smoking among women, although it is also possible that women are more susceptible to the harmful effects of cigarette smoke and other known COPD risk factors.

Participants were drawn from the long-running Genetic Epidemiology of COPD study (COPDGene), which seeks to find new information about genetic factors in COPD. The COPDGene study, involving 21 academic clinical centers, is an observational cohort of current and former smokers aged between 45 and 80 years at enrollment, who reported at least 10 pack-years of cigarette smoking and self-identified as either non-Hispanic white or African-American.

The objective of the present study was to explore gender-by-age interactions and disease severity as defined by GOLD groupings and the 3 key contributing elements of the GOLD classification system (symptoms, exacerbation risk, and airflow limitation severity) using data from a large well-phenotyped COPD cohort. A detailed approach was adopted to consider age by 5-year increments and to identify clinically relevant age cutoffs from which to examine these differences.

There were 2522 individuals with COPD in the under-65 year age group and 1962 in the 65 and older group. The proportion of women in each age group was similar (42.8% vs 45%); the majority of participants across both sexes were white and had higher education.

The study found:

• A higher proportion of men in the younger group were identified as current smokers (P <.001), although there were no gender differences in current smoking status among the older participants (P >.05).
• Younger women with COPD had 1.94 (95% CI 1.60—2.36) higher odds of reporting severe dyspnea compared with younger men with COPD. A significant age-by-gender interaction was also observed (P = .02).
• The association between gender and symptom reporting was attenuated among older participants. Older women with COPD remained significantly more likely to report severe dyspnea compared to older men with COPD (OR 1.38, 95% CI 1.11—1.71).
• Younger women with COPD had 1.53 (95% CI 1.27—1.84) higher odds for exacerbation risk compared to younger men with COPD. The association was weaker (OR 1.22, 95% CI 0.98–1.53) and non-significant among older participants, and no age-by-gender interaction was observed (P = .13).
• Younger women had 1.54 (95% CI 1.24—1.93) higher odds of having more severe airflow limitations according to GOLD groupings as compared to younger men. A significant age-by-gender interaction was also observed (P = .002).
• Younger women had higher odds of being classified with worse GOLD classifications compared to younger men (OR 2.07, 95% CI 1.67—2.56), despite lower pack-years of smoking.

The researchers said more studies are needed to understand the pathogenesis of increased severity of COPD in women and to develop gender-targeted clinical assessment and management approaches to improve outcomes for women and men with COPD at all ages.

Reference

DeMeo DL, Ramagopalan S, Kavati A, Vegesna A, Han MK, Yadao A, et al. Women manifest more severe COPD symptoms across the life course. [published online October 1, 2018]. Int J Chron Obstruct Pulmon Dis. doi: 10.2147/COPD.S160270