Chronic Obstructive Pulmonary Disease (COPD) in Women
Over ten million Americans suffer from Chronic Obstructive Pulmonary Disease (COPD), and unfortunately, this is now the third leading cause of death in the US. The number of women with COPD is increasing at a rate higher than men. In the last several decades, COPD prevalence and mortality among women have risen rapidly, and is now equivalent to men.
COPD impacts men and women differently. Women with COPD report more shortness of breath, and worse symptom-related quality of life. Women will more often report symptoms of anxiety and depression then men. A recent study found that 1 in 4 patients with COPD had persistent depressive symptoms over three years, and being female was associated with substantial increases in the odds of persistent depressive. COPD often co-exists with other smoking-related diseases, however the accompanying diseases tend to be different in men and women with COPD.
Women may also be more sensitive to the harming effects of tobacco smoke. Women who smoke experience a more rapid decline in their lung function then men. Women make up the majority of patients among non-smokers with COPD, and appear to be more sensitive to non-tobacco causes of COPD. In the developing world, biomass fuels used for cooking may be responsible for many cases of non-smoking COPD, and women may be more sensitive to environmental pollutants and second-hand smoke then men.
The reasons behind these differences are not well understood. Women have smaller lungs then men, and it is possible that for the same amount of cigarette smoking, they have greater exposure to the harmful effects of cigarette smoke. There are also differences in the type of cigarettes smoked. More women smoke menthol cigarettes, and these cigarettes are particularly harmful. There are also likely differences related to the hormone environments in men and women. Genetics also plays a role.
With these differences in the clinical presentation and susceptibility to COPD, it would seem that men and women would respond differently to standard treatments for COPD. Unfortunately, women have traditionally not been a large part of treatment trials for COPD, although this is now changing. Women demonstrate different responses to quitting smoking, and show greater improvement then men in lung function after quitting, but have more difficulty staying quit.
Along with the unfortunate risk in COPD among women, there is growing evidence that women with COPD have different symptoms and risk factors, and may require different treatment. In the BWH Women’s Lung Health Program, Drs. Megan Hardin, Barbara Cockrill, and Dawn DeMeo work with you to help you understand these differences and provide best possible care.