The rate of COPD (chronic obstructive pulmonary disease) in women is on the rise. A report released by the American Lung Association in June 2013 noted that women are 37 percent more likely to have COPD than men, and women now account for more than half of all deaths attributed to COPD in the United States.
According to Dr. Dennis E. Doherty, MD, FCCP, professor of medicine in the Division of Pulmonary, Critical Care and Sleep Medicine at the Lexington VA Medical Center and the University of Kentucky, research has shown that women are more susceptible than men to tobacco smoke, which is one of the primary causes of COPD. Other studies show women are often misdiagnosed with asthma rather than COPD.
Although smoking tobacco is the largest risk factor of COPD, Dr. Doherty says other risk factors for women can be secondhand smoke and also breathing in biomass fuels. “This is more of a problem in some areas of the world where women cook with coal or straw. They are in an environment (where) these biomass fuels are inhaled both day and night because it’s also their source of heat,” he explains.
Additionally, there is a genetic predisposition for COPD that causes a deficiency of Alpha 1-antitrypsin, a protein that protects the lungs from certain enzymes which, if left unchecked, can break down healthy lung tissue. According to Dr. Doherty, a large number of people in North Eastern Kentucky have this genetic predisposition.
Dr. Doherty says an early symptom of COPD is a chronic cough with phlegm/mucus production. However, many patients will not present until they have shortness of breath at rest or with minimal exertion, a point when on average, half their lung function is already gone. “Shortness of breath with more vigorous activities may not indicate that they are out of shape, but rather could be a sign that they have early COPD, which the time we need to intervene – earlier, before they progress to more severe disease,” Dr. Doherty explains.
COPD is usually diagnosed using a test called spirometry, where the patient takes as deep a breath as they can, and then exhales as hard as they can for as long as they can. Dr. Doherty explains that what they blow out in the first second is called FEV1 (forced expiratory volume in one second), and the total of air they blow out is FVC (forced vital capacity). The diagnosis is then determined by the ratio of FEV1/FVC. A ratio of less than 70 percent is a sign of COPD.
The first treatment for COPD is for the patient to stop smoking, which is not easy to do. “It’s harder to stop smoking than it is to stop addiction to alcohol or heroin – it’s been shown that there’s a higher relapse rate for smoking,” Dr. Doherty says.
The first line medicines in COPD, says Dr. Doherty, are those which maximize broncho-dilation (open up the airways) – they are called bronchodilators. There are two different classes of these medications – long-acting anticholinergics such as tiotropium, and beta-2 agonists such as formoterol, salmeterol, and indacaterol. If a patient’s symptoms worsen and they have frequent flares, Dr. Doherty says an inhaled corticosteroid may be added.
Non-pharmacological therapies include pulmonary rehabilitation, where patients are taught all about COPD, proper breathing techniques, and the importance of exercising, nutrition and vaccinations.
Dr. Doherty says complications that can arise in patients with COPD normally come as acute exacerbations of their symptoms – or “flares” – and can lead to hospitalization. Additionally, COPD patients are at a higher risk for lung cancer, largely because of their smoking history.
As for prevention, Dr. Doherty says the biggest measure women can take is to not start smoking. Although the rate of smoking in the United States is declining, and a number of communities in Kentucky have gone smoke-free, the rate of smoking in younger women is still high.
Another prevention measure is to get diagnosed earlier. “COPD is now thought to be a disease that can be diagnosed earlier during the course of the disease with spirometry testing,” Dr. Doherty says. “With proper therapy, COPD is partially reversible, so there is optimism.”
by Corrie Pelc