Research published October 1, 2018, in the International Journal of Chronic Obstructive Pulmonary Disease “suggests that we need to look more closely at women with shortness of breath and coughing to see if they should have a diagnosis of and treatment for COPD,” says Dawn DeMeo, MD, MPH, the lead author of the study and an associate professor at Harvard Medical School and Brigham and Women’s Hospital in Boston. The researchers for the new study are part of the COPDGene Study, a multicenter research effort looking at genetic factors in COPD.
Millions, Not Just Smokers, Living With COPD
COPD is an umbrella term for lung conditions that block airflow and make breathing difficult. Like asthma, COPD causes obstructive lung disease, in which flow through the bronchial tubes and air sacs is decreased with exhalation. According to the Centers for Disease Control and Prevention (CDC), close to 16 million Americans report having been diagnosed with COPD, though the actual number of people affected may be much higher. Smoking is the most common cause of COPD and accounts for about 8 out of 10 COPD-related deaths. But many people who suffer with COPD have never smoked. CDC data shows that even though age-adjusted death rates for COPD declined among U.S. men from 1999 to 2014, death rates have not changed significantly among women. According to a study published in the journal The Lancet, the average 35-year-old woman is more than 3 times as likely to get COPD as to develop breast cancer in her lifetime.
How the Study Was Conducted
The study included 4,484 current and former smokers with COPD between the ages of 45 and 80 — 2,522 were younger than 65, and 1,962 were 65 or older. Women made up 43 to 45 percent of participants in the groups. While a higher percentage of men in the younger group were identified as current smokers, there was no difference in smoking status among the men and women in the older groups. The researchers assessed participants’ COPD severity using the GOLD (Global Initiative for Chronic Obstructive Lung Disease) grading system created by the National Heart, Lung, and Blood Institute and the World Health Organization. The GOLD system rates COPD severity from A (early) to D (very severe) based on several factors, including a person’s FEV1 score (the amount of air that can be forcibly expelled from the lungs in one second), frequency of exacerbations or flare-ups, hospitalizations, and degree of exertional dyspnea (breathlessness associated with physical activity). The researchers found that younger women with COPD were more likely to suffer severe dyspnea and airflow limitation, and they were at greater risk for exacerbations than men. While the difference was not as significant between older women and men overall, the study found that the older female participants were more likely to have severe dyspnea 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,” said the study’s authors.
Latest Findings Support Earlier Research
This is not the first study to suggest that women may be more severely affected by COPD symptoms than men. Previous research published in 2004 and in 2010 came to similar conclusions. Still, the authors of the new study believe their results “extend this previous work to show gender differences vary across the life course and persist.” Researchers admit they don’t know why COPD may affect women worse than men. They suggest that it may involve “multiple interacting mechanisms,” including physiology, behavior, and genetics. The severity of dyspnea may be associated with:
Differences in lung volume and sizeEvidence that the hormone estrogen may compound the effects of tobacco smoke
Dr. DeMeo hopes that increased awareness of gender differences in COPD patients will lead to earlier diagnosis and treatment in women. “This is an opportunity for women to advocate to get better screening and testing,” she says. “We have tended to treat every patient the same,” says study coauthor Barry Make, MD, codirector of the COPD program at National Jewish Health in Denver. “We’re not the same, and gender fits into that concept.”
