Emerging Face of COPD More Youthful, Female

Article excerpt

SAN DIEGO -- Chronic obstructive pulmonary disease, once thought of as a disease of elderly white men, is increasingly a disease of women of all ethnicities.

Ranking as the fourth leading cause of death in the United States, COPD is the only leading cause of death that is still increasing, and fast: 22% in the last decade, Dr. Kimberly A. Hardin said at Perspectives in Women's Health, sponsored by FAMILY PRACTICE NEWS, OB.GYN. NEWS, and INTERNAL MEDICINE NEWS.

"It's actually changing very much," she said, "It's becoming a younger person's disease ... with 70% of cases in patients younger than 65 ... and possibly a younger women's disease."

Already, women have surpassed men in COPD mortality, said Dr. Hardin, a pulmonologist and critical care specialist at the University of California, Davis, in Sacramento.

Rising rates of smoking among women are one causal factor, but more nonsmoking women than men are also being diagnosed with COPD, "so something else is going on with this."

Indeed, distinct differences in the manifestations of the disease suggest significant gender disparities in COPD, according to Dr. Hardin.

Among the disparities:

* CT scans show more architectural alveolar destruction in men's lungs, correlating with the fact that men seem more susceptible to emphysema.

* In women, COPD is more often an airway disease, harder to detect and more closely associated with chronic bronchitis.

* COPD appears more difficult to control in women, and they have higher rates of exacerbation and more hospitalizations.

* Women have increased airway responsiveness, compared with men.

* Women are more often misdiagnosed with asthma than are men.

* Forced expiratory volume in 1 second declines more rapidly in women, even in nonsmokers or if pack-years of exposure to tobacco are taken into account.

* Inflammation, which plays a key role in COPD pathology, seems especially important in women with the disease. For example, women have increased lung inflammation even after they stop smoking, and nearly a third of nonsmoking women with COPD also have autoimmune diseases.

Theories abound as to the gender differences, which are only recently being fully explored. …