Chronic obstructive pulmonary disease (COPD), the fourth leading cause of death globally, claimed 3.5 million lives in 2021, approximately 5% of all global deaths ¹ with a growing and disproportionate impact on women. COPD ² is no longer a respiratory disease that predominantly affects men. The prevalence among women has risen, where women are 37% more likely than men to have COPD, revealing significant gender disparities in diagnosis and treatment.

In the USA, COPD is the leading cause of death in women with 6.7% of adult women having reported to suffer from COPD in 2022 ³. Low-and middle-income countries (LMIC) bear the heaviest burden, where nearly 90% of COPD deaths are in those under 70 years of age. Tobacco smoking is responsible for only 30–40% of cases in LMIC while over 70% in high income countries. A large percentage are also affected due to household air pollution, which mainly affects women due to their traditional roles in domestic settings ⁴.

Identifying why Women are at Risk
Current prevalence rates show COPD affecting 15.47% of men and 8.79% of women ⁵, highlighting the need to address gender disparities in diagnosis and treatment ⁶. Women often face distinct obstacles when getting their condition recognized and effectively managed. Women with COPD often experience more severe symptoms, including higher shortness of breath, increased anxiety and depression, which can significantly affect their quality of life.

In many countries, COPD is more common in women, especially among the younger populations. Evidence also shows that women are more vulnerable to developing COPD and experiencing faster disease progression than men at similar exposure levels. This trend has sparked a debate about the link between gender and COPD susceptibility, which can be partly attributed to differences in lung physiology, suggesting a potential genetic component to women’s vulnerability to COPD.

Understanding the Challenges in Diagnosis
Despite the growing prevalence of COPD in women, they are frequently misdiagnosed, often with asthma. Traditional gender roles further delay diagnosis, especially in areas where healthcare access is limited. Additionally, women encounter multiple barriers—economic, cultural, and social—that prevent them from seeking timely care.

Compounding the issue, women are often exposed to indoor air pollution, which significantly increases their risk of COPD. Moreover, societal stigmas and stereotypes about women’s health usually leads to their symptoms being dismissed or underestimated by healthcare providers. Biological differences-such as smaller lung size, lower airway responsiveness, and the influence of hormonal changes-can further complicate diagnosis.

¹ Chronic obstructive pulmonary disease (COPD) (who.int)

² COPD rates rise in women – Harvard Health

³ Prevalence of COPD among adults by gender U.S. 2011-2022 | Statista

⁴ news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)

⁵ Estimating the global prevalence of chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis | BMC Public Health | Full Text (biomedcentral.com)

⁶ Women’s COPD – PMC (nih.gov)

Recognizing the Inequity and Gaps in Care
The disparities in COPD care go beyond diagnosis, with women frequently receiving fewer treatment options compared to men. According to the Global Asthma Report 2022, more than 35 million Indians suffer from asthma and COPD, yet less than 30% are aware of their condition ⁷. Moreover, 90% of patients use their inhalers incorrectly, hindering effective treatment.

To address this issue, patient support programs such as the Joint Airways Initiative — a digital asthma education platform that provides one-on-one training to over 10,000 patients annually, focusing on correct inhalation techniques — offer valuable resources. In addition to this proven intervention, these platforms also provide a range of other services, including pulmonary physiotherapy, dietary counseling, yoga, and medication adherence support.

Studies show that women are less likely to be prescribed therapies like bronchodilators and are often excluded from pulmonary rehabilitation programs, which are essential for managing COPD ⁸.

Hormonal influences, particularly fluctuations in estrogen, can impact disease progression and the efficacy of treatments in women. Ongoing research suggests that estrogen may worsen lung inflammation, potentially leading to more severe COPD symptoms in women. This is a significant finding that underscores the need for more research in this area.

However, treatment protocols often do not take these hormonal differences into account, leading to a one-size-fits-all approach, which is detrimental to women. Moreover, economic and social barriers further exacerbate the inequities in care. Women, especially in low-income settings, may have limited access to COPD medications, oxygen therapy, and regular follow-ups, significantly affecting disease management and quality of life.

Moving Toward Gender-Specific Care
Addressing gender-specific disparities in diagnosis and treatment through a multi-faceted approach is critical for improving outcomes for women with COPD. Awareness campaigns targeting healthcare professionals and the public are crucial for reducing the disease burden and improving the diagnosis.

Incorporating gender-specific guidelines in management and treatment, improving access to healthcare, particularly in low-income and rural areas, and offering schemes and programs to reduce the financial burden of treatment are some steps that can make a significant difference. Furthermore, encouraging research on how biological and hormonal differences impact COPD progression and treatment in women can lead to more effective and tailored interventions.

The persistent gender disparities in COPD diagnosis and treatment underscore the need for a gender-sensitive approach to COPD care. Personalized approaches for optimal treatment in women with COPD are very critical for the overall management of COPD.

On World COPD Day, let’s ‘Know Your Lung Function’ by promoting awareness and knowledge sharing to address gender disparities and improve outcomes for women living with COPD. This shift towards gender-specific care is not just a matter of equality but a crucial step in enhancing the overall management of COPD and reducing its global impact.

⁷ https://globalasthmareport.org/resources/Global_Asthma_Report_2022.pdf

⁸ Pulmonary rehabilitation for chronic obstructive pulmonary disease – PMC (nih.gov)

This article was first published in the CNBC TV18 on November 20, 2024