Women and COPDMoustapha Salah Mounib

Military Medical Academy

Introduction

COPD and women…….it’s a combination that, until recent years, has not drawn much attention. But, as the rise in prevalence in COPD in women increases, it appears that exploring gender differences in COPD is a topic worthy of consideration .

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 women who died from the disease was five to one.

The way COPD was envisioned 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 in creased in recent years .

Biological Differences

Female lungs are smaller than men’s, with narrower airways and less respiratory muscles to power inhaling and exhaling. As a result, the concentration of cigarette smoke and other lung irritants is higher within the lungs airways of women when inhaled.

The smaller structures of the lungs also makes women more susceptible to bronchial hyper-responsiveness. The affected airways become thickened and inflamed, which, makes breathing more difficult and damages tissue over time.

Female sex hormones, specifically estrogen, play a role in worsening the lung damage from smoking in women as well. Estrogen increases the rate at which nicotine is broken down in the body, but it does not increase the rate that the body gets rid of these harmful compounds. This increased metabolism of nicotine may also explain why it is much more difficult for women to quit smoking than men.

Not All Symptoms Are Created Equal

The hallmark symptoms of COPD: dyspnea, chronic cough and sputum production. Current research supports that the effects COPD has on women are 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.•Furthermore, women have more frequent exacerbations than men, and are at greater risk of malnutrition.

Gender- Bias in COPD Diagnosis

Studies suggest 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. This is why spirometry testing is so important for women found to be at risk for COPD.

But, I Never Smoked A Day In My Life

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

Other risk factors known to cause COPD :•Second hand smoke.•Biological dusts, such as pollen, animal dander, insects parts, fungi and bacteria ( health care, food and textile manufacturing, cleaning )….occupational hazards.•Out door pollution.•In Egypt , specially in rural areas, biomass fuel.

Smoking Cessation: A Primary Treatment Goal

Smoking cessation remains the single most, cost-effective intervention for any one 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 symptoms improvement.

Should Treatment Options for Women Be Different

Current COPD guidelines have yet to recommend different treatment options for men and women. In women with COPD, there are some treatment considerations to be aware of.

•Inhaled Corticosteroids are often used in the treatment. Women using ICS should be aware that they decrease bone density and increase osteoporosis and hip fractures.•Women were found to have lower body mass index than men. When body BMI is lower than 21, COPD mortality increases so it is important to have a proper nutrition

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