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

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.

Impact of Genetic Polymorphisms on Human Immune Cell Gene Expression

“…GWAS studies have strongly implicated FAM13A as a susceptibility gene for chronic obstructive pulmonary disease (COPD) (Cho et al, 2014), and subjects with the risk alleles express higher levels of FAM13A in lung tissue (Kim et al, 2014). The higher expression of FAM13A among females that we found may help to explain their greater risk for developing severe early onset COPD with less cigarette-smoking exposure compared to males (Aryal et al, 2014). Further, our studies point to CD4 + T cells, especially from females, as highly susceptible to the effects of COPD-risk alleles in the FAM13A locus.…”

Disability-Free Life Expectancy Over 30 Years: A Growing Female Disadvantage in the US Population

“…17 Second, causes of death have also shifted; US women are now as likely as men to die from chronic respiratory disease and 30% more likely than men to die from Alzheimer's disease. 18,19 Third, a substantial decline in late-life disability prevalence has been documented for this country for the 1980s and 1990s, 20–23 but a recent flattening suggestive of an impending reversal has been identified, along with increased prevalence relative to earlier decades among those approaching later life. 24,25 Others have noted recent increases in more moderate disability among older adults.…”

What factors influence an early COPD diagnosis in primary care?

“…The influence of gender on diagnosis COPD among women is on the rise (Csikesz and Gartman, 2014;Aryal et al, 2014), and has now equalised between the genders (Wisnivesky et al, 2014;GOLD, 2017). This is likely due to the increased prevalence of smoking among women (Schirnhofer et al, 2007;Forey et al, 2011;Delgado et al, 2016;GOLD, 2017), or exposure to other risk factors, such as indoor pollution (Schirnhofer et al, 2007;GOLD, 2017).…”