COPD: An Equal Opportunity Disease

By Dr. David Mannino, University of Kentucky

This 1960s jingle comes from a cigarette ad targeted at women. During this time in U.S. history, an important theme was the emergence of equal rights for people regardless of gender, race or ethnicity. This equality transcended many areas of our lives, including the advertising and marketing of cigarettes. Of course by the early 1970s, cigarette ads were no longer being advertised on television.

By the late 1970s, I was in medical school in Philadelphia, and the second patient I saw as a medical student was an elderly black man with COPD. I’ll never forget watching him sit on the side of his bed with his hands braced against his nightstand as he gasped for each breath. In that day our treatment of COPD was limited to steroids, theophylline, and oxygen. Over the next few years of my training, I continued to care for many men with COPD.

A Shift For the Worse
In the late 1980s, we saw a change in the population with the increasing number of women being admitted to the hospital with COPD. If we fast-forward to my present day outpatient clinic, most of my patients are now women and—with better treatment options— hospitalizations have become unusual events in my patients’ lives.

Diseases of the lungs have not, traditionally, been considered as affecting a large portion of women. Sixty years ago the overwhelming majority of smokers in the U.S. were men, and men, in large part, occupied the jobs that exposed the lungs to toxins that could cause damage. This pattern changed in the 1950s, with women taking up smoking in large numbers and also moving into jobs that used to be male-dominated. A net result of this change has been the increasing number of COPD cases and deaths among women. The year 2000 was a watershed year for COPD among women because it was the first year in the U.S. where more women than men died from COPD. These numbers have continued to increase in subsequent years.

Women who have COPD have some specific areas that require additional attention from their providers. For example, women are at an increased risk for osteoporosis, and patients with COPD are also at an increased risk. Thus, women with COPD are at a very high risk and should be evaluated and receive intervention as appropriate. Similarly, a low body mass index increases the risk of complications and death in COPD patients, and women tend to have lower body mass indexes compared to men. Thus, it is extremely important for women with COPD to be sure they are following a healthy diet and maintaining their body weight.

Gotta Quit the Cig!
The key interventions for COPD are tobacco treatment, pulmonary rehabilitation, oxygen (if a patient qualifies), and medical management. These interventions are important among both men and women. The most important intervention—for patients who are still smoking—is the adequate treatment of their tobacco addiction. In my practice, women frequently have had a harder time quitting smoking than men.

There are numerous behavioral and medical interventions available to our patients to assist in this endeavor. A pulmonary rehabilitation or exercise program is the next critical component of the comprehensive treatment of COPD. COPD patients typically cut down their activities because they get short of breath, and this may be even more common among women. Breaking this cycle is an important piece to improving the quality of life in our patients. Medical management includes both oxygen, when appropriate, and medication to improve airflow into the lungs and decrease the risk of exacerbations, which are acute worsening in the symptoms of COPD.

An Equal Opportunity Disease
COPD has truly become an equal opportunity disease, affecting individuals of all races and ages, but affecting more women than men in the U.S. The good news is that our patients, both men and women, are living longer and fuller lives. COPD is preventable and treatable and we hope that someday it will be curable.

If you have COPD, learn as much as you can about the disease, your options to maximize your potential, and take your medical therapy as directed. The therapy available today is much better than what was available 30 years ago, which help reduce hospitalizations and improve the quality of life for our COPD patients. If you have a loved one with COPD, be sure they are getting the best care possible.