Attitudes Toward the Diagnosis of Chronic Obstructive Pulmonary Disease in Primary Care

Miravitlles, Marc; Roza, Cristian de la; Naberán, Karlos; Lamban, Maite; Gobartt, Elena; Martín, Antonio

doi:10.1016/s1579-2129(06)60106-7

Cited by 39 publications

(56 citation statements)

References 26 publications

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“…28 In the respiratory community, there has been suspicion that women with COPD could be underdiagnosed, based on results of two studies demonstrating that given similar clinical scenarios, physicians are more likely to make a diagnosis of COPD in male vs. female subjects. 29,30 Our data provide, for the first time, evidence that women with COPD actually perceive a delay in diagnosis. Whether these data represent a difference in the propensity to self-identify a need of care or an actual gender-related difficulty in obtaining the care is unclear and will need to be evaluated in further prospective evaluations.…”

Section: Discussionmentioning

confidence: 58%

Gender Differences in Symptoms and Care Delivery for Chronic Obstructive Pulmonary Disease

Martínez

Raparla²,

Plauschinat³

et al. 2012

Journal of Women's Health

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Background: Morbidity and mortality for women with chronic obstructive pulmonary disease (COPD) are increasing, and little is known about gender differences in perception of COPD care. Methods: Surveys were administered to a convenience sample of COPD patients to evaluate perceptions about symptoms, barriers to care, and sources of information about COPD. Results: Data on 295 female and 273 male participants were analyzed. With similar frequencies, women and men reported dyspnea and rated their health as poor/very poor. Although more women than men reported annual household income < $30,000, no significant gender differences in frequency of health insurance, physician visits, or ever having had spirometry were detected. In adjusted models (1) women were more likely to report COPD diagnostic delay (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.13-2.45, p = 0.01), although anxiety (OR 1.83, 95% CI 1.10-3.06, p = 0.02) and history of exacerbations (OR 1.60, 95% CI 1.08-2.37, p = 0.01) were also significant predictors, (2) female gender was associated with difficulty reaching one's physician (OR 2.54, 95% CI 1.33-4.86, p = 0.004), as was prior history of exacerbations (OR 2.25, 95% CI 1.21-4.20, p = 0.01), and (3) female gender (OR 2.15, 95% CI 1.10-4.21, p = 0.02) was the only significant predictor for finding time spent with their physician as insufficient. Conclusions: Significant gender-related differences in the perception of COPD healthcare delivery exist, revealing an opportunity to better understand what influences these attitudes and to improve care for both men and women.

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Section: Discussionmentioning

confidence: 58%

Gender Differences in Symptoms and Care Delivery for Chronic Obstructive Pulmonary Disease

Martínez

Raparla²,

Plauschinat³

et al. 2012

Journal of Women's Health

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“…When spirometric data were provided, the difference in rate of COPD diagnosis between the sexes narrowed (76% for the man vs. 64.6% for the woman). In a more recent similar study conducted in Spain, COPD was also more likely to be the primary diagnosis for men than for women (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.15-2.1) (13). Interestingly, this gender bias disappeared after physicians were shown the abnormal results of spirometry, which emphasizes the importance of ordering spirometry.…”

Section: Gender Bias In Diagnosis Of Diseasementioning

confidence: 96%

Gender and Chronic Obstructive Pulmonary Disease

Han¹,

Postma²,

Mannino³

et al. 2007

Am J Respir Crit Care Med

299

224

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5Pulmonary and Critical Care Section, Veterans Affairs Health System, Ann Arbor, MichiganThe prevalence of chronic obstructive pulmonary disease (COPD) in women is increasing, as is hospitalization for COPD. The number of women dying of COPD in the United States now surpasses men. Despite this, research suggests that physicians are still more likely to correctly diagnose men with COPD than women. Increased tobacco use in women likely explains some of the increase in the prevalence of COPD in women, but data suggest that women may actually be at greater risk of smoking-induced lung function impairment, more severe dyspnea, and poorer health status for the same level of tobacco exposure. The degree to which these observations represent biologic, physiologic, or sociologic differences is not known. Nonsmokers with COPD are also more likely to be female. In addition, new evidence is emerging that men and women may be phenotypically different in their response to tobacco smoke, with men being more prone to an emphysematous phenotype and women an airway predominant phenotype. Inasmuch as COPD is a disease of inflammation, it is also possible that sexual dimorphism of the human immune response may also be responsible for gender differences in the disease. More data are still needed on what the implications of these findings are on therapy. In this clinical commentary, we present current knowledge regarding how gender influences the epidemiology, diagnosis, and presentation of COPD in addition to physiologic and psychologic impairments and we attempt to offer insight into why these differences might exist and how this may influence therapeutic management.

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“…One North American study found that physicians presented with a clinical vignette suggestive of COPD were significantly less likely to diagnose COPD when the patient was described as female compared with male (11). A similar study found that differences in the rates of diagnosis disappeared when spirometry data were presented (12), underscoring the importance of obtaining spirometry in patients with symptoms suggestive of COPD. Currently, only approximately one-third of patients with a diagnosis of COPD in the United States have undergone confirmatory spirometry (13).…”

Section: Importance Of Diagnosismentioning

confidence: 99%

Women and Lung Disease. Sex Differences and Global Health Disparities

Pinkerton

Harbaugh

Han

et al. 2015

Am J Respir Crit Care Med

121

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There is growing evidence that a number of pulmonary diseases affect women differently and with a greater degree of severity than men. The causes for such sex disparity is the focus of this Blue Conference Perspective review, which explores basic cellular and molecular mechanisms, life stages, and clinical outcomes based on environmental, sociocultural, occupational, and infectious scenarios, as well as medical health beliefs. Owing to the breadth of issues related to women and lung disease, we present examples of both basic and clinical concepts that may be the cause for pulmonary disease disparity in women. These examples include those diseases that predominantly affect women, as well as the rising incidence among women for diseases traditionally occurring in men, such as chronic obstructive pulmonary disease. Sociocultural implications of pulmonary disease attributable to biomass burning and infectious diseases among women in low-to middle-income countries are reviewed, as are disparities in respiratory health among sexual minority women in high-income countries. The implications of the use of complementary and alternative medicine by women to influence respiratory disease are examined, and future directions for research on women and respiratory health are provided.

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Attitudes Toward the Diagnosis of Chronic Obstructive Pulmonary Disease in Primary Care

Cited by 39 publications

References 26 publications

Gender Differences in Symptoms and Care Delivery for Chronic Obstructive Pulmonary Disease

Gender Differences in Symptoms and Care Delivery for Chronic Obstructive Pulmonary Disease

Gender and Chronic Obstructive Pulmonary Disease

Women and Lung Disease. Sex Differences and Global Health Disparities

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