COPD More Prevalent in Women and Affects Them Differently Than Men, Report Finds

Chronic obstructive pulmonary disease (COPD) is an incurable, progressive lung disease that was most recently in the news for taking the life of former First Lady Barbara Bush. Last fall, researchers gathered for 2 days to discuss and explore research needs and opportunities related to the impact of female sex and gender on lung and sleep health maintenance and management of lung diseases and sleep disorders, of which COPD is one of the best-known examples.

A report from that workshop meeting, organized by the National Heart, Lung, and Blood Institute (NHLBI) in partnership with the National Institutes of Health Office of Research on Women’s Health (ORWH) and the Office of Rare Diseases Research (ORDR), details many of the ways that COPD has, in fact, become a women’s disease.

COPD prevalence is increasing more rapidly in women, particularly in younger women, and COPD-related hospitalizations and deaths in women also surpass men. A report from the American Lung Association said more than 7 million women have COPD, and millions more have symptoms but have not been diagnosed. Women also predominate the roughly 25% of nonsmokers with COPD.

Sex-specific susceptibility to COPD is poorly understood, although previous research suggests that women are more vulnerable to the effects of tobacco smoke due to estrogen impacts or because of other biological factors, such as shorter height and reduced lung size. Molecular analyses suggest sex differences in inflammatory burden, according to the workshop report, which was published in the American Journal of Respiratory and Critical Care.

In addition, social factors, such as the higher likelihood of exposure to secondhand smoke and air pollution due to women being more likely to live below the poverty line, may also play a role.

Women are also more likely to be misdiagnosed by providers and have a delayed diagnosis, perhaps because of a lack of availability of providers and poor insurance.

Women report more shortness of breath than men despite similar lung function testing and fewer years of smoking. A greater prevalence of anxiety and depression and increased frequency of COPD exacerbations in women may be a factor in those differences, the report said.

The report said that it is crucial to find gender-specific approaches to COPD.

Reference

Han MK, Arteaga-Solis E, Blenis J, et al. Female sex and gender in lung/sleep health and disease: increased understanding of basic biological, pathophysiological and behavioral mechanisms leading to better health for female patients with lung disease. [published online May 10, 2018]. Am J Respir Crit Care Med. doi: 10.1164/rccm.201801-0168WS