COPD is Not Just for Men Anymore
COPD? What’s that? Oh, yeah...it’s a disease that has to do with emphysema. Old men get it, right?”
Well, yes… but unfortunately for women the face of COPD has changed. COPD (Chronic Obstructive Pulmonary Disease - a combination of emphysema and chronic bronchitis), is now not only as common in women as it is in men; but in the year 2000 women – for the first time ever – passed up men in deaths due to COPD.
Researchers are just beginning to scratch the surface in learning about COPD in women – how women differ from men in diagnosis, smoking addiction and quitting, and in the disease itself. Here’s some of what they’ve found so far.
The prevalence of COPD is increasing in women. In addition to this increase, rates of hospitalization in women are also rising. Since the year 2000 US deaths resulting from COPD in women have exceeded those in men.
Differences in Smoking and Quitting
COPD in women can be different than COPD in men. Some of the rise in COPD prevalence in women may be explained by increased tobacco use beginning in the 1950s. Yet, women appear to be at greater risk of smoking-induced lung disease, compared with men, for the same amount of tobacco exposure. This is especially interesting because compared with men, women have more difficulty quitting smoking and remaining abstinent from tobacco. However, sustained female quitters have two and a half times greater improvement in a major measurement of lung function, FEV1 (Forced expiratory volume in the first second of exhaling), than do men.
So, even though smoking cessation appears to benefit women more than men in terms of lung function, the benefit is felt less by women when it comes to relief of symptoms. This might explain why women are less likely than men to sustain long-term abstinence.
Nicotine replacement therapy reduces cravings less effectively for women than for men and is associated with greater weight gain. However, women may still benefit significantly from smoking cessation therapies. Treatment with Bupropion (Welbutrin) or with Varenicline (Chantix or Champix) has been shown to be equally effective in both sexes.
Differences in Symptoms
Compared with men who have COPD, women with COPD report more severe shortness of breath, more anxiety and depression, and lower disease-related quality of life. When stopping treatment of inhaled steroids (Flovent, Pulmicort, Azmacort, Qvar, etc), women appear to have a greater likelihood of respiratory deterioration than do men.
Higher risk of smoking-induced lung function impairment, greater shortness of breath (SOB), and worse health status in women than in men exposed to the same amount of tobacco may be related to biologic, physiologic, or sociologic sex differences, but more research must be done.
The response to tobacco smoke may vary between men and women, with men more likely to develop emphysema-type (air sac or alveoli) damage and women more likely to have airway-predominant (chronic bronchitis) changes.
Differences in Diagnosis
So far this article has focused on men and women with smoking as the cause of their COPD. But, it’s important to note that not all COPD is caused by smoking. In fact, although about 85 percent of people with COPD are or were cigarette smokers, only about 20 percent of people who smoke ever have symptoms of COPD.
Nonsmokers with COPD are more likely to be female, suggesting genetic sex-linked factors that predispose them to developing COPD. This could be one reason why doctors are more likely to miss the diagnosis of COPD in women than in men and are less likely to order pulmonary function testing.
Another major cause of COPD in women
Women appear to be more vulnerable to developing COPD from exposure to smoke from burning biomass fuels used for cooking in many developing regions of the world. In a recent article, Katelyn Harding of the COPD Foundation states, “Every year two million people in developing countries die from indoor air pollution. Of those two million deaths, 54 percent are from COPD. People who cook their food using biomass fuels—wood, charcoal, crop residues, animal dung, and coal—are using primitive and inefficient stoves, which results in significant indoor air pollution; fumes, smoke and contaminants created from these stoves.
According to a 2009 study from the World Health Organization and the United Nations Development Programme, three billion people—or almost half of humanity—rely on traditional biomass as the available modern energy services fail to meet their needs.”
We’ve got a lot to learn about COPD and women. But here is something we already know for sure: If you’re woman – or a man – with difficulty breathing, a chronic cough and/or frequent lung infections, you should be checked for COPD! Even if you never smoked, urge your doctor to order a simple lung function test. You owe it to yourself to understand what’s going on in your lungs and how you can keep on breathing well for a long time to come.
Jane M. Martin is a licensed respiratory therapist, teacher and the founder and director of http://www.Breathingbetterlivingwell.com and author of Breathe Better, Live in Wellness.