Closing the Gap: Identifying and Treating COPD in Women

Posted on November 20, 2023   |   

This article was written by Dr. Byron Thomashow and Dr. Caroline Carter.

Do you have cough that won't go away? Or feel like you're breathing through a straw? Do you stop halfway up the stairs because you need to catch your breath? If so, it's time to pay attention. These are all signs of a potentially serious condition - chronic obstructive pulmonary disease (COPD).

COPD is a chronic, progressive lung disease that affects more than 30 million people in the United States, and shockingly, over 15 million of them remain undiagnosed. It comprises several conditions, including chronic bronchitis and emphysema, and can be caused by genetics and irritants like smoke or pollution. In the United States cigarette smoking remains the most common cause but data suggests that 25-40% of COPD occurs in never smokers.

While COPD is widely recognized, there are concerning gender differences in its diagnosis and management. Research has brought to light a significant increase in the number of women being diagnosed with COPD. While mortality rates for COPD have been decreasing, mortality rates are falling slower in women. Women now account for a higher proportion of COPD hospitalizations and in-hospital COPD related deaths. Despite this, women often experience delayed diagnoses compared to men, and it's often challenging for women to receive timely and accurate diagnoses.

Women are struggling with COPD more than men. Here's why.

Healthcare Bias

Women develop COPD earlier in life than men, but tend to receive a diagnosis later. Some healthcare providers continue to think COPD is primarily a male disease, resulting in underdiagnosis and undertreatment in women. Healthcare providers may overlook respiratory (lung) symptoms in women or think they are part of other conditions like asthma, contributing to delayed diagnosis. As a result, women potentially have more years of breathing difficulty and long-term frustration as treatments can be less effective against more advanced cases of COPD. It is essential to talk to your primary care doctor if you are experiencing symptoms of COPD.

Biological Factors

Women are more vulnerable than men to the harmful effects of cigarette smoke and other irritants such as air pollution. This may be because women's lungs and airways tend to be smaller than men's, making COPD lung inflammation more severe. Hormonal factors, such as the drop in estrogen (a hormone) after menopause, may also play a role in the increased vulnerability of women to COPD. These differences are why a gender-specific approach to the diagnosis and treatment of COPD is crucial.

Behavioral Trends

Women have been smoking more in the past few decades, contributing to more fatal cases of COPD. Women who smoke also develop COPD at younger ages than men, and because of their heightened vulnerability, it takes less smoking than men to develop COPD.

The danger of smoking can't be overstated - women who smoke are nearly 22 times more likely to die from COPD than women who have never smoked. The good news is women who quit may enjoy greater benefits than men.

But smoking alone can't explain why women have worse COPD outcomes overall. If COPD risks were equal between men and women, we would see a 50-50 split for cases among those who have never smoked, but that's not the case. In fact, estimates suggest that some 80% of never smokers with COPD are women. Using biomass fuels for cooking is increasingly recognized as an important environmental cause of COPD worldwide, particularly in women.

Differences in the Disease Process

Evidence suggests that women may exhibit distinct inflammatory pathways in COPD. Hormonal changes and genetic differences between genders can influence inflammation in the lungs. Understanding these gender-specific differences in the disease process could lead to the development of targeted therapies and tailored treatment strategies for women with COPD.

Women May Experience Different COPD Symptoms than Men

COPD symptoms can vary between individuals, and women may experience symptom patterns different from men. Women with COPD often present with chronic cough, shortness of breath during exercise, or wheezing. These symptoms may be mistakenly thought to be other respiratory conditions, such as asthma, or simply brushed off as signs of aging or being out of shape.

Speaking with your primary care doctor is vital for your health

It's important to not overlook common COPD symptoms such as persistent coughing, shortness of breath, wheezing, or chest tightness. To keep your lungs healthy and have the best results, early detection and management of COPD are crucial. Your primary care doctor plays a vital role in this process, serving as a reliable person that you can talk to about your symptoms and creating a management plan that is specific to you. Seeking prompt treatment is essential because if you wait too long, your lungs could get even worse.

Your primary care doctor can use routine tests to help identify COPD at an earlier stage. A test that measures lung function called spirometry is needed to confirm a COPD diagnosis. To better determine who needs spirometry, a tool called CAPTURE, the “COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk,” has been developed. CAPTURE includes a short questionnaire and a very simple and inexpensive breathing test, Peak Flow Testing. In a recent study, CAPTURE correctly found nearly half of the people with COPD who were previously undiagnosed. Taking action when COPD is found early can improve the quality of life for women with COPD.

Primary care doctors play a key role in identifying the “missing millions” of people in America who have undiagnosed COPD. That's why the COPD Foundation, a nonprofit organization established to improve the lives of people with COPD, and Village Medical, a primary care provider, began a partnership this year. This collaboration will raise COPD awareness through education and outreach campaigns to patients, help identify those with undiagnosed COPD, and increase access to pulmonary rehabilitation.

Our message to women is this:

Make a habit of seeing your primary care provider at least once a year to take proactive steps against COPD. Talk to your doctor if you have any of the early signs of COPD. That discussion could be the difference between breathing well with treatment and dealing with lifelong lung damage. It could even be the difference between life and death. With the help of a trusted provider, you can take the first step in identifying your COPD risks and finding the best course of care for you to prevent or manage the condition long term.

Dr. Caroline Carter, MD, is board certified in Family Medicine and practices in Sugar Land, Texas.

Dr. Byron Thomashow, MD, a Professor of Medicine at Columbia University Medical Center, and an Attending Physician at the New York-Presbyterian Hospital. He helped found the COPD Foundation in 2004, served as Chairman of the Board of Directors for ten years, served as chief medical officer for the last five years and now serves as Senior Medical Advisor for the Foundation.


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  • Thank you Crystal Rothhaar, BS.
  • I'll never know if being diagnosed earlier would have made a difference, but I suspect it would have. I quite smoking in my early- to mid-30s (I'm now 75) because I was already experiencing SOB from smoking, primarily, I assume. Some other environmental pollutants were probably also involved. Didn't get diagnosed until 4 years ago and my primary symptoms are still mostly apparent during exercise... I also sometimes question my pulmonologist about medication dosages; I'm 5'8" and maybe 118 lbs (have a lot of trouble keeping/putting on weight) yet am prescribed the same amounts of medication as, say, a 250 lb male would be. Pretty sure that's unnecessary and could even be harmful so we discuss. :)
    Thank you for this.

    • TX Blue, you're not the first person to wonder about dosage, and rightly so! I remember listening at a conference that was easily 15 years ago (maybe more) to a friend who is tall and slender (I'm not!) asking that same question of a panel of COPD experts. To a person, they all sort of sat back and you could see them thinking. Their advice, and she took it, was to talk with her doc and maybe do some experimenting with her meds. She has continued to do that to this day, and it's worked well for her. I hope you can try that!