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Women manifest more severe COPD symptoms across the life course

Dawn L De Meo, Sreeram Ramagopalan, Abhishek Kavati, et al. On behalf of COPDGene Investigators.
Int J Chron Obstruct Pulmon Dis 2018;13:3021–29.
doi: COPD.S160270

Prevalence of chronic obstructive pulmonary disease (COPD), and mortality associated with the disease, have increased among women in recent decades – in spite of women being less likely to be diagnosed, and more likely to experience a delay in diagnosis. Studies have indicated that women with COPD report more severe dyspnoea and a higher rate of exacerbations than men.

This analysis of data from the COPDGene study (a multicentre observational cohort of US participants aged 45–80 years) included information from 4,484 people with spirometry-confirmed COPD. Statistical analysis recommended the use of 65 years as a meaningful cut-off point for age-group analysis. ‘Younger’ patients were therefore defined as those aged below 65 years.

Younger women were nearly twice as likely as younger men to report severe dyspnoea. They also had 1.53-times higher odds for exacerbation risk and 1.54-times higher odds of more severe airflow limitation (Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 2–4) than men. Finally, younger women were more likely than men to be classified in GOLD group D versus A, despite having fewer smoking pack-years. However, all these associations were attenuated in the older patients.

The study concludes that younger women are more likely to manifest more severe symptoms and therefore more severe GOLD classification than younger men; these gender associations were less pronounced among older adults. Reasons for the observed differences are not clear but may involve physiological (e.g. lower absolute lung volumes, effects of oestrogen on susceptibility to cigarette smoke), behavioural (e.g. higher rates of anxiety and depression) and/or genetic mechanisms.

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