Published ahead of print on August 2, 2007, doi:10.1164/rccm.200704-553CC Am. J. Respir. Crit. Care Med., Volume 176, Number 12, December 2007, 1179-1184 A more recent version of this article appeared on December 15, 2007
Submitted on April 9, 2007 Gender and COPD: Why it MattersMeiLan K Han1,1 Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, United States, 2 University Medical Center Groningen, Groningen, The Netherlands, 3 Division of Pulmonary and Critical Care Medicine, University of Kentucky, Lexington, KY, USA, 4 Division of Pulmonary and Critical Care Medicine, Oregon Health and Sciences University, Portland, OR, USA, 5 Division of Pulmonary & Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, United States; Pulmonary and Critical Care Section, Veterans Affairs Health System, Ann Arbor, MI, USA * To whom correspondence should be addressed. E-mail: fmartine{at}umich.edu.
The prevalence of chronic obstructive pulmonary disease (COPD) in women is increasing, as is hospitalization for COPD. The number of women dying from COPD in the USA 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 suggests 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 are not known. Nonsmokers with COPD are also more likely to be female. In addition, new evidence is emerging that the 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. In as much 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 pulmonary perspective, we present current knowledge regarding how gender influences the epidemiology, diagnosis, and presentation of COPD in addition to physiologic and psychological impairments and 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
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