Features of COPD In Women

Introduction

COPD is the 6th leading cause of death in the United States and the 4th worldwide. The most common forms of COPD are chronic bronchitis (coughing up mucus or phlegm most days for at least two years) and emphysema (destruction of the alveoli or air sacs in the lung). In about 20% of those diagnosed with COPD, there is an overlap with asthma. This means that a person can have features of both asthma and COPD. Since 2008, the prevalence (how common is it?) of COPD in women has been the same as in men.

Information about COPD in women. Taken from Chest March 2017.

Risk Factors For Women Developing COPD

Smoking. Cigarette smoking is the major risk factor for COPD among both men and women. Because women’s lungs and airways are smaller than those of men, cigarette smoking may be more dangerous to women’s lungs. For every cigarette smoked, women tend to get more severe COPD at an earlier age. Even exposure to second hand smoke from parents and/or a spouse over years can damage the lungs and lead to COPD.

About 25 to 30% of those diagnosed with COPD have never smoked which includes about 3 out of 10 women. Other risk factors for COPD include exposure to biomass fuel used for cooking, occupational exposure to dusts and gases, history of pulmonary tuberculosis, chronic asthma, respiratory-tract infections during childhood, outdoor air pollution, and poor socioeconomic status.

Biomass Fuels.

Although these may not be used much in the United States, biomass fuels are used to cook in developing countries resulting in continuous indoor exposure. Biomass fuels include firewood, wood chips, agricultural crops such as corn, soybeans, sugar cane, paper, lawn clippings, and leaves. For example, in India cooking with biomass fuels is common in rural areas and often unavoidable due to socioeconomic factors and limited access to cleaner fuel sources.

Symptoms Of COPD In Women

COPD impacts men and women differently. For example, women with COPD report more shortness of breath along with worse symptom-related quality of life. Generally, women experience these symptoms earlier and for longer time periods before they are diagnosed with COPD.

Mean St George’s Respiratory Questionnaire Questionnaire (SGRQ) scores according to sex in a study that included 90 patients with COPD (60 male subjects and 30 female subjects; mean age: 64 ± 9 years) with a wide range of airway obstruction disorders (mean FEV1: 56% ± 19% of predicted). Lower scores are worse. Taken from the J Bras Pneumol. 2010;36(1): pages 37-43.

In addition, women with COPD are more likely to have depression, anxiety, and osteoporosis (thinning of the bones). 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 depression. Overall, these symptoms can contribute to fraility - an increased vulnerability to adverse (bad) health outcomes such as falls, hospitalizations, and disability. Women have also been shown to experience a higher frequency of flare-ups (exacerbations) than men.

Social Determinants Of Health In COPD

Research shows that COPD rates are higher among people in rural areas and lower in those with higher monthly household incomes. Dr. Dawn DeMeo, a pulmonary and critical care specialist at Harvard Medical School, has stated that, “In COPD issues like poverty disproportionately impact women.”

Treatment Of COPD

Current evidence from studies show that women have similar responses to inhaled therapies as do men. However, older age, short stature, and being female are factors associated with reduced values for peak inspiratory flow (PIF) - a measure of inspiratory ability - that is required to use a dry powder inhaler optimally.

If you do not experience that it is easier to breathe with your dry powder inhaler, OR not sure if you are inhaling the powder medication deep into your lungs, then ask your health care professional to have your PIF measured when you have pulmonary function tests. If your PIF value is low, then a different delivery system can be considered.