COPD and women -- it's a combination that, until recent years, has not drawn much attention. But, as the rise in prevalence of COPD in women increases, it appears that exploring gender differences in COPD is a topic worthy of our consideration and one that shows promise to promote change in how women with COPD are treated, clinically.
Historically, there exists a perception that COPD occurs more predominantly in men than women. This observation was perhaps initially supported by statistics such as those in 1959, when the number of men compared to women who died from the disease was five to one. The way we envisioned COPD began to change, however, as mortality rates in women dying from the disease between 1968 and 1999 increased by 382 percent, while in men, only 27 percent.
As the death toll in women continues to rise, the year 2000 marked the first year that more women than men died from COPD. This trend is expected to continue and likely to grow, as the number of women smokers has also increased in recent years.
Not All Symptoms Are Created Equal
The hallmark symptoms of COPD include dyspnea, chronic cough and sputum production. Current research supports that the effects COPD has on women are far more detrimental than they are in men suggesting gender-related differences in COPD symptoms. Reportedly, women are more likely to experience the following symptomatic variations:
- More severe shortness of breath
- More anxiety and depression
- A lower quality of life
- Increased airway hyper-responsiveness
- Worse exercise performance (data limited to two small studies)
Gender-Bias in COPD Diagnosis
Two studies suggest that physicians are more likely to give a COPD diagnosis to a male patient rather than a female, in spite of having similar symptoms. This implies that there may be a gender bias when it comes to making a COPD diagnosis. Moreover, women are also less likely to be offered a spirometry test or referred to a specialist.
Once doctors receive abnormal spirometry results, however, this gender bias seems to disappear. This is why spirometry testing is so important for both men AND women found to be at risk for COPD.
Women More Susceptible to Harmful Effects of Tobacco
There is growing evidence to support that women are more likely to have a greater reduction in lung function at comparable levels of smoking than men. This may be because women's lungs are generally smaller, possibly exposing them to a greater amount of tobacco smoke despite men smoking the same number of cigarettes.
Other possible explanations for women being more susceptible to the harmful effects of tobacco smoke include:
- Possible under-reporting of tobacco consumption among women
- A genetic predisposition for lung damage from smoking that is gender-specific
- Levels of secondhand smoke exposure
- Differences in cigarette brands
- Hormonal effects on lung development and size of the airways
- Differences in the way women metabolize cigarette smoke
But, I Never Smoked a Day in My Life
Roughly 15% of all people who are diagnosed with COPD have never smoked. Notably, out of this group, nearly 80% are women, suggesting that women may be more vulnerable to risk factors associated with COPD that are not related to smoking.
Smoking Cessation: A Primary Treatment Goal
Smoking cessation remains the single most important, cost-effective intervention for anyone with COPD, regardless of gender. But, women who are successful at quitting show an average increase in FEV1% predicted that is 2.5 times greater the improvement in men during the first year of quitting. Additionally, research suggests that women who quit smoking benefit more in terms of lung function than do men, but that men show greater symptom improvement. Some believe that this is why women, statistically, have a harder time quitting than men.
Should Treatment Options for Women Be Different?
Current COPD guidelines have yet to recommend different treatment options for men and women. Whether this practice will change as research advances has yet to be seen. If you are a woman with COPD, however, there are treatment considerations that you should be aware of:
- Inhaled corticosteroids (ICS) are often used in COPD treatment to prevent COPD exacerbation in those with severe, or very severe, COPD. Women using ICS should be aware that they may decrease bone density and increase the risk of osteoporosis and hip fracture. Because women are already at greater risk for osteoporosis, women using ICS should also receive calcium and Vitamin D supplements, bisphosphonates and have their bone density monitored as recommended by their doctor.
- Studies have shown that women are more likely to use a metered does inhaler (MDI) incorrectly than men. If you are a woman who uses an MDI, make sure you know how to use it effectively.
- Oxygen therapy is recommended for some patients who have low blood oxygen levels. One study suggests that women treated with long-term oxygen therapy have better survival rates than men. Talk to your doctor for more information.
- When discontinuing ICS, women may have a higher probability of respiratory deterioration than men causing symptoms to worsen or COPD exacerbation. If you are planning to stop using your ICS, talk to your doctor first to discuss your options.
- In a 2005 CHEST study, women were found to have lower body mass index (BMI) than men. When BMI is lower than 21, COPD mortality increases so it's important to eat right and add calories to your diet if you have a lower than normal BMI.
The increase in prevalence in COPD among women has prompted much needed research that is ongoing and future-driven. While current treatment guidelines remain the same for men and women, a customized treatment program for women may be something worth considering if it will positively impact how women live and cope with the disease.
Cote, C.G., Chapman, K.R. Diagnosis and treatment considerations for women with COPD. March, 2009.
Han, et al. Gender and Chronic Obstructive Pulmonary Disease: Why It Matters. August, 2007.
Torres et al. Gender and COPD in Patients Attending a Pulmonary Clinic. CHEST 2005.