Clinicians should be alert to the stereotype that the typical COPD patient is an elderly male, as the majority are now women.
Dr Seppo Rinne, from Yale University, told the ATS meeting that women with COPD dominated every age group in the United States and now accounted for 60% of cases. They tended to present at a younger age, and with a lower smoking history.
“After controlling for as many confounding factors as possible, their risk seems to be about 40% higher,” he said. “Contributors might include smaller airways, holding inhaled smoke for longer in the lungs, and the effects of oestrogen on the metabolism of smoke products.”
Mortality is higher in women with COPD, perhaps because of differences in the initial presentation of the disease, the treatment provided by their doctors, adherence to medications, and medication side effects.
“While several studies have shown gender differences in therapy for other chronic diseases, there is limited research on how COPD management differs between men and women,” Dr Rinne said.
He compared 1,149 women and 32,409 men with COPD admitted to 130 (male-dominated) Veterans Affairs hospitals between 2008 and 2011. The comprehensive analysis included a wide range of demographic and clinical information, and the prescription of short-acting bronchodilators, long-acting bronchodilators, inhaled corticosteroids and oral steroids.
Compared with men, women were younger (63 vs 69 years) and less likely to have a prior hospital admissions (42% vs 48%).
Although women were more likely to also have asthma (34% vs 17%) and depression (33% vs 20%), they were less likely to have comorbidities including ischaemic heart disease, heart failure and chronic kidney disease.
“Women with COPD were significantly less likely to have received appropriate outpatient treatments prior to admission, with lower rates of short-acting beta agonists, ipratropium, long-acting beta agonists and tiotropium inhalers, but they were prescribed similar rates of inhaled and oral steroids,” Dr Rinne said.
The findings about medication use persisted after controlling for baseline characteristics.
Despite the differences in outpatient management, there were no differences in hospital outcomes between men and women.
“We need to re-evaluate the bias that we bring to the treatment of women with COPD,” he concluded.