COPD: Are you at risk?

COPD: Could you be at risk?

Why women need to be concerned about this growing threat to our health.

COPD is a lung condition that includes both emphysema (damage to the air sacs of the lungs) and chronic bronchitis (blockage from too much mucus in the airways). People with COPD often have a chronic cough and trouble breathing.

There was a time when chronic obstructive pulmonary disease (COPD) was considered a man's disease. For most of the 20th century, men accounted for most COPD cases—and deaths. But by the turn of the millennium, men no longer held a monopoly on this progressive lung condition.

"In the year 2000, the number of women dying from COPD surpassed the number of men dying from COPD," says Dr. Dawn DeMeo, associate professor of medicine at Harvard Medical School and pulmonologist at Brigham and Women's Hospital.

Today, women are 37% more likely to have COPD than men, and we account for more than half of the deaths from this disease. The trend started in the 1960s, when marketing campaigns like the famous Virginia Slims "You've come a long way, baby" ad made smoking socially acceptable for women, who embraced this habit by the millions. "Given the lag time in lung disease, we're probably just starting to see the apogee of the trends in cigarette smoking," Dr. DeMeo says.

More vulnerable lungs Smoking is the No. 1 cause of COPD in the Western world in both genders, but researchers are discovering that women may be even more vulnerable than men to the effects of smoke on their lungs. Dr. DeMeo and her colleagues highlighted this finding in a 2010 study in the journal Thorax, when they discovered that women with COPD had worse lung function and more severe disease than men. "For every cigarette smoked, women seem to develop more severe lung disease at an earlier age," she says.

At first, researchers attributed this disparity to anatomy. Because women have smaller lungs, we have less surface area over which to distribute cigarette smoke and other pollutants. At a higher concentration, these toxins can cause greater damage.

Now researchers are looking at other possible factors. For example, the female sex hormone estrogen may alter the way a woman's body breaks down harmful compounds in cigarette smoke. "We're trying to tackle this from all different angles. Is it anatomy, is it hormones, or is it some different physiology? No one really knows yet," Dr. DeMeo says.

Talking to your doctor "I think any woman with a personal history of smoking should consider having that dialogue with her physician," suggests Dr. DeMeo. Even if you quit smoking many years or decades ago, you can still develop the disease. She also advises women to learn their family history of COPD, which increases the risk for this disease, potentially even in those who've never smoked. It's also important for women to recognize symptoms like shortness of breath and coughing as possible signs of COPD and get them checked out by their doctor, rather than writing them off as fatigue, aging, poor fitness, or overexertion.

COPD is diagnosed with a test called spirometry to find out how well your lungs are working.

You breathe out as hard as you can into a tube, which measures the outward force of your breath and how much air your lungs can hold.

The importance of treatment If you do have COPD, getting treated is important. When you can't breathe well, your quality of life suffers. Untreated COPD can lead to a range of complications, even depression.

Quitting smoking is key to slowing COPD progression. "There have been research studies suggesting that women have a steeper or faster decline in lung function than men, especially if they continue to smoke," Dr. DeMeo says.

If you've tried quitting before with no success, ask your doctor about combining methods such as counseling and medication. You can also get help from phone support lines, websites, and apps that you download to your smartphone.

No matter how many years you've been smoking or how far your COPD has progressed, you can still improve your health by quitting. Treatments such as inhaled bronchodilator or oral steroid medicines can open up the airways and help you breathe easier. Your doctor may also recommend pulmonary rehabilitation—a program of exercise, nutritional counseling, and disease management training that can help you gain better control over your condition.

Resources to help you quit smoking   

SmokefreeWomen women.smokefree.gov Become an Ex www.becomeanex.org LiveHelp Online Chat livehelp.cancer.gov/app/chat/chat_launch — Harvard Medical Health (June 2014)