Published ahead of print on August 2, 2007, doi:10.1164/rccm.200704-553CC
© 2007 American Thoracic Society doi: 10.1164/rccm.200704-553CC
Gender and Chronic Obstructive Pulmonary DiseaseWhy It Matters1 Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan; 2 University Medical Center Groningen, Groningen, The Netherlands; 3 Division of Pulmonary and Critical Care Medicine, University of Kentucky, Lexington, Kentucky; 4 Division of Pulmonary and Critical Care Medicine, Oregon Health and Sciences University, Portland, Oregon; and 5 Pulmonary and Critical Care Section, Veterans Affairs Health System, Ann Arbor, Michigan Correspondence and requests for reprints should be addressed to Fernando J. Martinez, M.D., M.S., 1500 East Medical Center Drive, 3916 Taubman Center, Ann Arbor, MI 48109-0360. E-mail: fmartine{at}umich.edu ABSTRACT The 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.
Key Words: tobacco susceptibility • smoking • sex • obstructive lung disease This article has been cited by other articles:
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