Gender Differences in COPD

When many think of chronic obstructive pulmonary disease (COPD), they think of it as a man's disease. But, as the prevalence of COPD in women increases, it's important to explore the gender differences in COPD. Here's what you need to know about how COPD affects women differently than men.

The idea that COPD is a disease that mainly men have to worry about was initially supported by statistics in 1959 when the number of men compared with women who died from the disease was five to one. However, the number of women dying from COPD between 1968 and 1999 increased by 382 percent, while in men, there was only a 27 percent increase. The year 2000 marked the first year that more women than men died from COPD, and that trend has continued.

The hallmark symptoms of COPD include dyspnea, chronic cough, and sputum production. Experts have recently found that the effects of COPD in women are far more detrimental than they are in men. Women are more likely to experience the following symptoms:

• More severe shortness of breath
• More anxiety and depression
• Lower quality of life
• Increased airway hyperresponsiveness
• Worse exercise performance

Furthermore, women have more frequent exacerbations than men do and are at greater risk of malnutrition.

Research shows that physicians are more likely to give a COPD diagnosis to a male patient rather than a female, even if the patients have 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 be 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 who are found to be at risk for COPD.

There is growing evidence 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, so the lungs are possibly exposed to a greater amount of tobacco smoke, even when the women are smoking the same number of cigarettes as men. 

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 that women metabolize cigarette smoke

Roughly 15 percent of all people who are diagnosed with COPD have never smoked. Notably, out of this group, nearly 80 percent are women, suggesting that women may be more vulnerable to risk factors that are associated with COPD that are not related to smoking.

Smoking cessation remains the most important and the most cost-effective intervention for anyone with COPD, regardless of gender. It is especially beneficial for women. 

A spirometry test measures something called FEV1 (forced expiratory volume in one second). It's essentially the amount of air that you can exhale from the lungs forcibly in one second. Women with COPD who quit smoking tend to show an average increase in FEV1 in one year that's 2.5 times greater than the improvement that's seen in men. This means that lung function may improve more in women than in men in the first year after quitting smoking. However, other research has shown that men report greater symptom improvement after quitting smoking than women do.

Current COPD guidelines have yet to recommend different treatment options for men and women, though it's possible that this practice will change as research advances. If you are a woman with COPD, however, there are certain treatment considerations that you should be aware of.

• Inhaled corticosteroids (ICS): These are often used in COPD treatment to prevent COPD exacerbation in those with severe COPD (and women are more likely to have severe COPD). Women using ICS should be aware that they may decrease bone density and increase the risk of osteoporosis and hip fracture. Since women are already at a greater risk for osteoporosis than men, women using ICS should also talk to their doctor about taking calcium and vitamin D supplements, taking bisphosphonates, and having their bone density monitored. Also, keep this in mind: When discontinuing ICS, women may have a higher probability of respiratory deterioration than men. If you are planning to stop using your ICS, talk to your doctor first to discuss your options.
• Metered Dose Inhalers (MDIs): Studies have shown that women are more likely to incorrectly use an MDI than men. If you are a woman who uses an MDI, make sure that you know how to use it effectively.
• Oxygen therapy: This type of therapy is recommended for some patients who have low blood oxygen levels. One study suggests that women who are treated with long-term oxygen therapy have better survival rates than men. Talk to your doctor for more information.