Elsevier

Translational Research

Volume 162, Issue 4, October 2013, Pages 208-218
Translational Research

In-Depth Review: Unraveling the Complexity of COPD
Review Article
COPD and gender differences: an update

https://doi.org/10.1016/j.trsl.2013.04.003Get rights and content

Chronic obstructive lung disease (COPD) is one of the most prevalent health conditions, and a major cause of morbidity and mortality around the globe. Once thought of primarily as a disease of men, COPD is now known to be increasingly prevalent among women. Although increasing tobacco consumption among women during the past several decades might explain some of this increase, the relationship may be more complex, including factors such as differential susceptibility to tobacco, anatomic and hormonal differences, behavioral differences, and differences in response to available therapeutic modalities. Moreover, women with COPD may present differently, may have a different pattern of comorbidities, and may have a better survival after acute exacerbations. Care providers continue to have a gender bias that may affect both diagnosis and treatment. Future work should focus on factors that lead to gender differences in COPD as well as gender-specific treatment strategies.

Section snippets

Epidemiologic Trends

COPD is a major source of morbidity and mortality around the globe and has a large burden on individuals, families, and society. COPD is estimated to be responsible for 250 deaths per hour worldwide, with the annual deaths from the disease surpassing lung cancer and breast cancer combined.1 The World Health Organization estimates that COPD will rank fifth in the global burden of disease by 2020.2 Despite COPD being an extremely prevalent disease, the measurement and monitoring of the true

Potential Reasons for the Gender Differences

Some experts believe the disparity in COPD between the genders is mostly a result of behavioral and environmental reasons, whereas others argue that biologic and gender-based genetic factors are equally if not more important. The following are the explanations that have been offered for the observed gender differences in COPD.

Gender Differences in Clinical Presentation

Several studies in the have shown that men and women present with different clinical symptoms of COPD. Table I36, 37 is a summary from some of those studies.3

According to these studies, women with COPD are more likely report dyspnea,38, 39 but less likely to report phlegm production.6, 37 Moreover, women seem to have a higher intensity of dyspnea despite relatively fewer pack-years of smoking and a similar FEV1.39 A recent study from Spain also showed that women reported less phlegm than males,

Gender Differences in Comorbidities

COPD exists with many other comorbid diseases. Although the gender differences in comorbidities are relatively understudied, there are observations that suggest that men and women differ in their pattern of comorbid diseases. In the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints cohort, cardiovascular comorbidity and diabetes mellitus were less prevalent in females, whereas osteoporosis, inflammatory bowel disease, reflux, and depression requiring treatment were

Gender Differences in Acute Exacerbations of COPD

There may be differences between males and females in outcomes of acute exacerbations of COPD, with women having a survival advantage. Patil et al54 found an increased risk for in-hospital mortality in men in an administrative data analysis of more than 70,000 patients admitted for an acute exacerbation of COPD. In another study of patients presenting in the emergency department with COPD, Cydulka et al37 found higher relapse rates among men compared with women, despite no difference in care

Smoking cessation

Most cases of COPD in the developed world are the result of tobacco smoking, and cessation of smoking is the primary intervention currently known to slow lung function decline.57 Females seem to be more susceptible to the effects of tobacco, as discussed earlier. Studies have shown that women tend to quit less frequently and also have a lower success rate of long-term smoking cessation than men; it has been argued that this may be, in part, because women tend to have less symptomatic benefit

Bias in diagnosis of COPD

Despite the increase in the prevalence of COPD among women, health care providers remain more likely to diagnosis COPD in males than females. Some of this bias may be related to the difference in clinical presentation, as noted earlier, but the notion that COPD is a male disease still seems ingrained in health care providers. The first study looking at gender bias was done in 2001 in the United States and Canada by Chapman et al,74 who were intrigued by the increase in the proportion of females

Conclusions

There are significant gender differences in COPD that seem to be a result of both environmental/behavioral factors and genetic/biophysiological differences in the 2 genders. Yet, many questions remain unanswered. A systematic research for reasons and mechanisms behind these factors, as well as differences in the pattern of comorbidities, exacerbations, as well as therapeutic modalities used in COPD, would help us understand COPD better and ultimately improve outcomes in the whole population.

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    Conflict of Interest: All authors have read the journal’s policy on conflicts of interest. S. Aryal and E. Diaz-Guzman have no conflicts of interest to disclose. D. M. Mannino has the following disclosures: He has served on advisory boards for Boehringer Ingelheim, Pfizer, GlaxoSmithKline, Sepracor, Astra-Zeneca, Novartis, and Ortho Biotech; and has received research grants from Astra-Zeneca, GlaxoSmithKline, Novartis, and Pfizer.

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