COPD in women: Unique challenges and considerations

Chronic obstructive pulmonary disease, or COPD, uniquely affects women presenting challenges for doctors in diagnosing, managing, and treating the disease. Let’s explore the many distinct issues females face including the causes of COPD, the symptoms that lead to a late diagnosis and poorer quality of life, and the realities of underdiagnosis, misdiagnosis, and accessing care.

Prevalence and causes of COPD in women #

While COPD, the third leading cause of death, was once more common among males, it is now increasingly prevalent in women.¹ According to the World Health Organization, COPD in the United States declined in men and increased in women between 1998 and 2009.¹ Today, COPD has become the number one cause of death among smoking women in the United States.¹

So what role does smoking, the number one cause of COPD, play in this increase among women? A quick peek into history sheds some light. The tobacco trend took hold among females when their status began changing in the 20^th century and became stronger in the 1950s and 1970s due to advertising portraying it as glamorous and slimming.¹

Today, in the United States and Europe, smoking is declining as more people are aware of its harmful effects.¹ In light of this shift, the tobacco industry is now focusing on females in developing countries.¹ The rise in COPD among women in these areas and the increased smoking rates are believed to be linked.²

However, other factors beyond smoking are at play and should be considered when diagnosing COPD. For instance, as many as 45% of COPD patients are non-smokers.³ The Australian Longitudinal Study on Women’s Health (ALSWH) collected data over 23 years from four cohorts of Australian women to uncover potential COPD predictors.³ The data showed that those with breathing difficulties, asthma, allergies, hay fever, or sinusitis all at baseline, who also self-reported as never having smoked and who did not have COPD at baseline, were more than twice as likely to be diagnosed with COPD later in life compared to those without these symptoms.³

Indoor air pollution is another major factor contributing to COPD in women. In countries with developing economies, close to three billion people rely on wood, charcoal, dung, or crop waste—known as biomass fuels—for cooking and heating.⁴ These fuels release high levels of carbon monoxide and household air pollution (HAP) such as soot particles that settle in the lungs.⁴ This affects more women since they are often responsible for cooking and household care.⁴

In addition, COPD can stem from genetics, abnormal lung development, infections, and uncontrolled and severe asthma. And, in some cases, the cause may be unknown or a mixture of factors.⁵

Delay in diagnosis of COPD in women #

Women with COPD exhibit different and more severe symptoms than men despite having the same disease severity which creates confusion when diagnosing COPD.⁶ Although cough and sputum are not as likely to be reported by women, their dyspnea (shortness of breath) rates are higher.⁶ Additional symptoms include anxiety and depression.⁶ Women with COPD also experience more lung cancer, undernutrition, and osteoporosis, while cardiovascular comorbidities are found more often in men.⁶

Delays in diagnosis for women are partly due to physician bias, underuse of spirometry, lack of gender-specific analysis in studies and trials, and fewer treatment options for COPD.⁶ Additionally, more men are enrolled in pulmonary rehabilitation studies and pharmacologic trials.⁶

How COPD affects women differently #

Female smokers develop COPD at a younger age despite a history of smoking less than men.⁷ Women may find quitting more difficult, and higher rates of anxiety and depression may reduce their success.⁷

Studies also show greater quality of life deterioration in women.⁷ A population-based study known as The European Community Respiratory Health Survey, found that women experience dyspnea, also known as shortness of breath, twice as often as men.⁷ Women have a faster annual decline in FEV1 (forced expiratory volume) and are more prone to exacerbations.⁷ In addition, women are more likely to experience hospitalization and even death.⁷

Challenges for managing COPD in women #

There are many challenges for managing COPD in women. Women face more frequent under-diagnosis, receive fewer spirometry tests, and experience reduced access to medical consultations compared to men.⁶ They are also more often misdiagnosed as asthmatic, when they actually may have both COPD and asthma, which leads to delay in treatment and fewer options.⁸

In addition, due to the generally smaller size of the lungs and airways of women, smoking cigarettes may present a greater risk to women.⁸ Evidence also shows that estrogen may influence how smoke is metabolized, making women more physically vulnerable.⁹

Conclusion #

Understanding the unique ways COPD affects women is critical to proper diagnosis, management, and treatment. Early diagnosis helps treatment plans begin sooner and can positively impact patient outcomes. Further research is needed to understand how best to support females with COPD.⁶

Written by

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  Kelly Sicard

  MA

  Kelly M. Sicard is a freelance writer with an M.A. in English & Creative Writing who spent over a decade working for a non-profit lung health organization. She lives in New Hampshire with her husband, daughter, and black labrador and enjoys reading, writing, listening to stories, appreciating nature, and spending time with family.