Gender-Related Differences in Severe, Early-Onset Chronic Obstructive Pulmonary Disease

Abstract

Men have higher prevalence rates of chronic obstructive pulmonary disease (COPD) than women, which has been attributed to the historically higher rates of cigarette smoking in males. However, the increased rates of cigarette smoking in females within the last several decades have been associated with steadily increasing rates of COPD in women. As part of a study of the genetics of severe, early-onset COPD, we assembled a group of 84 probands with severe, early-onset COPD (without severe alpha(1)-antitrypsin deficiency) and 348 of their first-degree relatives. We found a markedly elevated prevalence (71.4%) of females among the early-onset COPD probands. Among the entire group of first-degree relatives of early-onset COPD probands, univariate analysis demonstrated similar spirometric values and bronchodilator responsiveness in males and females; however, among current or ex-smokers, female first-degree relatives had significantly lower FEV(1)/ FVC (81.4 +/- 17.2% in females versus 87.0 +/- 12.9% in males, p = 0.009) and significantly greater bronchodilator responsiveness (expressed as percentage of baseline FEV(1)) (7.7 +/- 9.4% pred in females versus 4.1 +/- 6.4% pred in males, p = 0.002). Female smoking first-degree relatives were significantly more likely to demonstrate profound reductions in FEV(1) (< 40% pred) than male smoking first-degree relatives (p = 0. 03). Multivariate analysis, performed with generalized estimating equations, demonstrated that current or ex-smoking female first-degree relatives had significantly greater risk of FEV(1) < 80% pred (OR 1.91, 95% CI 1.03- 3.54), FEV(1) < 40% pred (OR 3.56, 95% CI 1.08-11.71), and bronchodilator response greater than 10% of baseline FEV(1) (OR 4.74, 95% CI 1.91-11.75). These results suggest that women may be more susceptible to the development of severe COPD.

Telomerase and the Genetics of Emphysema Susceptibility. Implications for Pathogenesis Paradigms and Patient Care

“…Among the small series of patients with telomeraseassociated emphysema heretofore reported, 90% are female even though the populations studied have been equally divided between males and females (33). Interestingly, this female predominance of severe disease among telomerase mutation carriers recapitulates a pattern previously documented in a Boston-based study of familial COPD in which 80% of probands younger than 53 years were female (6,34). Importantly, the female-predominant susceptibility in telomerase mutation carriers contrasts with the predilection to disease manifesting earlier and more severely in men with alpha-1 antitrypsin deficiency (35).…”

Respiratory diseases morbidity and mortality among adults attending a tertiary hospital in Nigeria

“…(9,27) The changing pattern of COPD is a reflection of the increasing prevalence of smoking among women, and studies have revealed that women are more susceptible to tobacco smoke than men. (28) An estimated 210 million people worldwide are affected by COPD, and 90% of COPD deaths occur in low-or middle-income countries. (29) The COPD-related mortality rate is projected to increase by more than 30% over the next 10 years unless immediate action is taken to reduce the prevalence of underlying risk factors, especially smoking.…”

COPD: problems in diagnosis and measurement

“…Furthermore, there have been significantly greater rates of FEV1 decline among female smokers compared with male smokers, as shown in an epidemiological setting in the Netherlands [54]. Finally, a sex difference in severe, earlyonset COPD has been demonstrated [55]. In the offspring of 84 individuals with severe, early-onset COPD, there was a markedly elevated prevalence (71.4%) in females.…”