Chronic Pulmonary Disease is a leading cause of death around the world. However mortality rates for women are higher than for men, who’s mortality rate has actually dropped between 1999 and 2006. The mortality rate for women however did not change and by 2000 women exceeded male mortality rates. This has prompted a shift in the perception that was once held that COPD was a ‘male disease’ and to look into why women are at a significant risk of death from COPD compared to men.
The primary risk factor for CPD is tobacco smoking. There is new evidence suggesting that the two genders differ in their susceptibility to the effects of smoking.
There may be a gender-specific genetic predisposition for lung damage, also women have smaller airways and therefore smoking the same amount of tobacco as men can result in proportionally more lung damage. Exposure to second-hand smoke, choice of cigarette brands and inhalation methods all may contribute to these gender differences. The number of women smoking also has increased dramatically over the last few decades.
These gender differences may start early in life and may be influenced by sex hormones. A study showed that young girls exposed to pollution and tobacco smoke showed greater lung reduction than the boys.
Smoking women are typically younger when they receive their COPD diagnosis and also the annual progression of COPD is more rapid in female smokers than in male smokers, even if they smoked for fewer years and smoked less than their male counterparts.
However 15% COPD diagnoses are non-smokers and of this group 80% are non-smokers suggesting that it is not just tobacco but other risk factors that contributes to a higher prevalence of COPD in women compared to men. Occupational exposures to dusts, coal and metallic fumes in the agricultural and industrial workplaces are a huge risk factor and over the last few decades more women have entered into these traditionally male occupations. In less-developed countries women are more likely to be employed in the textile, brass-ware, ceramics and glassware industries where there is a risk of exposure to damaging agents.
There is also a difference in the clinical symptoms experienced between the genders. Men report more sputum production and quality of life is lower for women who tend to suffer with higher rates of anxiety and depression and suffer more from shortness of breath. Men demonstrate higher rates of diabetes, sleep apnoea and cardiovascular disease whereas women tend to develop osteoporosis and bowel disease. Women also tend to suffer more with decreased BMI and higher airway obstruction readings and a poorer resulting prognosis. Women are also more likely than men to be diagnosed late, which also impacts upon their health and outlook if treatment is started later after more lung damage has occurred.
Upon diagnosis women tend to be younger than men and examination of their lung tissue shows that women in fact had more airway problems at that point, than men. This may explain why women experience more breathlessness and more of a decreased capacity to exercise than men.
These findings suggest that gender must be considered in future COPD studies and that gender is highly important in the treatment of COPD in the future. Gender-specific treatments may need to be developed as well as trying to diagnose women at an earlier point in their lung deterioration to increase survival rates for women.