Chronic obstructive pulmonary disease: are women more susceptible than men?
Section snippets
Epidemiology of chronic obstructive pulmonary disease
Among the tobacco-related illnesses, COPD has suffered a curious neglect by the medical community. Few physicians are aware that COPD is the only common cause of death that continues to increase in prevalence in North America; still fewer would know in the last decade COPD has risen from the fifth most common cause of death to the fourth most common cause of death [1], [2]. Almost none recognize that this trend is forecast to continue worldwide, making COPD one of the most common lethal
Women and cigarettes
Early in the twentieth century, smoking was uncommon among women and the cigarette was considered a disreputable form of tobacco consumption. Women smoked rarely and never in public. Organizations such as the Women's Christian Temperance Union encouraged the viewpoint that smoking cigarettes was immoral and scandalous. The tobacco industry exploited this taint of scandal, cleverly portraying the smoking of cigarettes as a badge of women's independence and right to choose [9]. As summarized by
The epidemiology of chronic obstructive pulmonary disease in women
The focus of this article is COPD as seen in Western developed nations where tobacco smoking is the major modifiable risk factor. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have defined COPD as chronic airflow limitation that arises as the result of chronic exposure to a noxious substance. In many parts of Africa and Asia, however, the noxious substance is the smoke from burning biomass fuels; the victims are most commonly women who have spent years tending
Gender bias in the diagnosis of chronic obstructive pulmonary disease
There is considerable evidence that COPD is underdiagnosed. The airflow limitation of COPD develops insidiously over decades and symptoms may be minimal, particularly in sedentary individuals. The problem of underdiagnosis of COPD was recently reviewed [22]. Typical of studies that examine the phenomenon, Renwick and Connolly [23] undertook a random sample of adults aged 45 and older in Manchester, United Kingdom. They found that obstructive airways disease was common in their population; of
Potential factors that account for women's increased predisposition to suffer from chronic obstructive pulmonary disease
Women may be predisposed to develop overt airway disease, in particular COPD, as the consequence of their smaller airway size. Regarded by some as a confounder in approaching the problem, this simple physiologic explanation accounts for the increased impact of tobacco smoking and suggests that women may be exposed to a greater dose of tobacco smoke than men for a given degree of tobacco exposure. That is, the average pack per day female smoker deposits the smoke into a smaller set of airways
The clinical course of chronic obstructive pulmonary disease in women
There has been little research that contrasts the clinical course of COPD in women and men but there is some evidence of important differences. Women who have COPD seem to have a greater risk of hospitalization than men. In the CCHS and GPS, women had a risk of COPD hospitalization that was between 1.5 and 3.6 times that of men [17]. These findings are consistent with greater severity of disease in women, different patterns of health care use between the sexes, different perception of symptoms
Summary
Current data show that women now suffer from COPD at least as commonly as men. They seem to be more predisposed to suffer the adverse respiratory consequences of tobacco smoking with the development of COPD at an earlier age and with a greater degree of lung function impairment for a given amount of tobacco exposure. This may be explained, in part, by women's greater airway responsiveness to exogenous stimuli—an increased responsiveness that is explained largely by differences in lung size and
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