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Influence of sex on chronic obstructive pulmonary disease risk and treatment outcomes.

Aryal S, Diaz-Guzman E, Mannino DM - Int J Chron Obstruct Pulmon Dis (2014)

Bottom Line: This has largely been attributed to historical increases in tobacco consumption among women.In addition, women with COPD are more likely to have a chronic bronchitis phenotype, suffer from less cardiovascular comorbidity, have more concomitant depression and osteoporosis, and have a better outcome with acute exacerbations.There are also differences in how men and women respond to different therapies.

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, NC, USA.

ABSTRACT
Chronic obstructive pulmonary disease (COPD), one of the most common chronic diseases and a leading cause of death, has historically been considered a disease of men. However, there has been a rapid increase in the prevalence, morbidity, and mortality of COPD in women over the last two decades. This has largely been attributed to historical increases in tobacco consumption among women. But the influence of sex on COPD is complex and involves several other factors, including differential susceptibility to the effects of tobacco, anatomic, hormonal, and behavioral differences, and differential response to therapy. Interestingly, nonsmokers with COPD are more likely to be women. In addition, women with COPD are more likely to have a chronic bronchitis phenotype, suffer from less cardiovascular comorbidity, have more concomitant depression and osteoporosis, and have a better outcome with acute exacerbations. Women historically have had lower mortality with COPD, but this is changing as well. There are also differences in how men and women respond to different therapies. Despite the changing face of COPD, care providers continue to harbor a sex bias, leading to underdiagnosis and delayed diagnosis of COPD in women. In this review, we present the current knowledge on the influence of sex on COPD risk factors, epidemiology, diagnosis, comorbidities, treatment, and outcomes, and how this knowledge may be applied to improve clinical practices and advance research.

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Changes in rates of death from chronic obstructive pulmonary disease over time among current female and male smokers in three time periods.Note: Reproduced from N Engl J Med, Thun MJ, Carter BD, Feskanich D, et al. 50-year trends in smoking-related mortality in the United States. 2013;368:351–364. Copyright ©2013 Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.80
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f2-copd-9-1145: Changes in rates of death from chronic obstructive pulmonary disease over time among current female and male smokers in three time periods.Note: Reproduced from N Engl J Med, Thun MJ, Carter BD, Feskanich D, et al. 50-year trends in smoking-related mortality in the United States. 2013;368:351–364. Copyright ©2013 Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.80

Mentions: A recent assessment of changes in mortality rates due to COPD in the cohorts from NHANES I and NHANES III in the US showed a smaller decrease in the mortality rate among women with moderate or severe COPD than among men (3.0% versus 17.8%).79 An analysis of smoking-related mortality in the US evaluated temporal trends in sex-specific smoking-related mortality across three time periods (1959–1965, 1982–1988, 2000–2010) in seven large cohorts.80 In the “contemporary” cohort (2000–2010), male and female current smokers had similar relative risks for mortality from COPD (26.61 for men, 22.35 for women), with these relative risks representing almost a doubling of risk compared to the 1982–1988 time period (Figure 2). The survival advantage that women with COPD have historically had has been slowly diminishing in recent years. Finally, in a recent analysis of the BOLD (Burden of Obstructive Lung Disease) cohort, spirometric restriction was more predictive of increased mortality risk than airflow obstruction in both the sexes, with worse mortality seen in lower-income groups.81


Influence of sex on chronic obstructive pulmonary disease risk and treatment outcomes.

Aryal S, Diaz-Guzman E, Mannino DM - Int J Chron Obstruct Pulmon Dis (2014)

Changes in rates of death from chronic obstructive pulmonary disease over time among current female and male smokers in three time periods.Note: Reproduced from N Engl J Med, Thun MJ, Carter BD, Feskanich D, et al. 50-year trends in smoking-related mortality in the United States. 2013;368:351–364. Copyright ©2013 Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.80
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4206206&req=5

f2-copd-9-1145: Changes in rates of death from chronic obstructive pulmonary disease over time among current female and male smokers in three time periods.Note: Reproduced from N Engl J Med, Thun MJ, Carter BD, Feskanich D, et al. 50-year trends in smoking-related mortality in the United States. 2013;368:351–364. Copyright ©2013 Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.80
Mentions: A recent assessment of changes in mortality rates due to COPD in the cohorts from NHANES I and NHANES III in the US showed a smaller decrease in the mortality rate among women with moderate or severe COPD than among men (3.0% versus 17.8%).79 An analysis of smoking-related mortality in the US evaluated temporal trends in sex-specific smoking-related mortality across three time periods (1959–1965, 1982–1988, 2000–2010) in seven large cohorts.80 In the “contemporary” cohort (2000–2010), male and female current smokers had similar relative risks for mortality from COPD (26.61 for men, 22.35 for women), with these relative risks representing almost a doubling of risk compared to the 1982–1988 time period (Figure 2). The survival advantage that women with COPD have historically had has been slowly diminishing in recent years. Finally, in a recent analysis of the BOLD (Burden of Obstructive Lung Disease) cohort, spirometric restriction was more predictive of increased mortality risk than airflow obstruction in both the sexes, with worse mortality seen in lower-income groups.81

Bottom Line: This has largely been attributed to historical increases in tobacco consumption among women.In addition, women with COPD are more likely to have a chronic bronchitis phenotype, suffer from less cardiovascular comorbidity, have more concomitant depression and osteoporosis, and have a better outcome with acute exacerbations.There are also differences in how men and women respond to different therapies.

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, NC, USA.

ABSTRACT
Chronic obstructive pulmonary disease (COPD), one of the most common chronic diseases and a leading cause of death, has historically been considered a disease of men. However, there has been a rapid increase in the prevalence, morbidity, and mortality of COPD in women over the last two decades. This has largely been attributed to historical increases in tobacco consumption among women. But the influence of sex on COPD is complex and involves several other factors, including differential susceptibility to the effects of tobacco, anatomic, hormonal, and behavioral differences, and differential response to therapy. Interestingly, nonsmokers with COPD are more likely to be women. In addition, women with COPD are more likely to have a chronic bronchitis phenotype, suffer from less cardiovascular comorbidity, have more concomitant depression and osteoporosis, and have a better outcome with acute exacerbations. Women historically have had lower mortality with COPD, but this is changing as well. There are also differences in how men and women respond to different therapies. Despite the changing face of COPD, care providers continue to harbor a sex bias, leading to underdiagnosis and delayed diagnosis of COPD in women. In this review, we present the current knowledge on the influence of sex on COPD risk factors, epidemiology, diagnosis, comorbidities, treatment, and outcomes, and how this knowledge may be applied to improve clinical practices and advance research.

Show MeSH
Related in: MedlinePlus