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Retired paralegal Patti Todd was devastated to learn she had COPD when she was 40 years old. I had lived with asthma for years, but hearing that I had COPD was a huge blow. He feared the diagnosis would affect his active lifestyle. “But the doctor explained that the less you do, the less you want to do,” he said. “Do everything you can to push yourself. Don’t limit yourself to doing the things you feel comfortable with.” So Todd got a step tracker and started taking 10,000 steps a day and staying active. His activity has decreased over time, but he still tries to do as much as he can.
COPD, short for chronic obstructive pulmonary disease, is the sixth main cause of death in the US and fourth worldwideaffecting people in rural areas the most. It is not just one disease, but a set of them. The most common forms of COPD are emphysema and chronic bronchitis. Asthma, which Todd had, can overlap and lead to COPD.
Historically, people have thought that lung diseases mainly affect men, but they are wrong. Lung diseases, such as COPD, hit womenand they hit hard. The mortality rate among men with COPD has been stable since the mid-1980s, but it has almost tripled among women, and more women die than men.
Smoking makes women more vulnerable to COPD
Smoking, a major risk factor for COPD, is stronger among women. “For every cigarette they smoke, women tend to suffer more serious lung diseases at a younger age,” he explained. Dawn DeMeo, MD, MPHpulmonary/critical care specialist and associate professor of medicine at Harvard Medical School. “Prior to the 1960s, smoking among women was a socially contentious issue.” To encourage smoking, tobacco companies focused on beauty, fitness, and finding one’s voice as a woman. This resulted in millions of women adopting the habit. And now, many of those women are living with severe COPD.
Todd quit smoking before his diagnosis. “I smoked around 15 and quit around 40, before I was diagnosed with COPD. “About six years later I was diagnosed and it was really shocking for me.” Todd thought that if he stopped smoking, the lung damage would not progress. “But it kept getting worse.”
However, smoking is not the only risk factor for COPD among women. Almost 3 out of 10 Women with COPD never smoked, compared with fewer than 1 in 10 men. “Some of the risk factors among women are exposure to biomass fuel used for cooking, other occupational exposures and genetic family history,” DeMeo said. While these biofuels may not be used in the US, some women who immigrate to North America may have been exposed to them since childhood, while their lungs were still forming.
Women are more vulnerable to airway injuries because their airways tend to be smaller and the hormonal changes that accompany menopause can also play a role. Some studies are showing early menopause can increase a woman’s risk of developing COPD, as can other reproductive factors, such as the age at which she had her first period and the number of pregnancies she has had.
Different symptoms of COPD and other conditions
Many health conditions, such as heart disease, cause different symptoms in women, and this is also the case with COPD. “Symptomatically, women may describe more cough and phlegm, potentially present with more difficulty breathing,” DeMeo said. Women’s symptoms are more severe and they have more outbreaks. “But I think one of the most surprising issues relates to the age of presentation and the symptoms, and how long those symptoms may have remained unaddressed and undiagnosed over time.” Women experience symptoms earlier and for a longer time before being diagnosed.
According to research, women with COPD are also more likely to have depression, anxiety and osteoporosisthinning of bones. Fragility is also something we need to worry about, DeMeo said. “That is an area of ongoing research, but also an opportunity for intervention. This is where [it’s important to make] Make sure you know that the woman with COPD has access to other providers to help her with nutrition, prevent weight loss and gain, depending on her response to steroids, and to address depression and anxiety.”
Social determinants of health also play a role in COPD
Where women live and work, their educational level, and their family income can also affect their COPD risk. Research shows that COPD rates are highest among people in rural areas and lower among people who completed high school and who had higher monthly household incomes. Additionally, people with COPD in lower income groups get worse faster compared to those at higher income levels. DeMeo points out that there are several reasons for this. “Do they live in a food desert? What kind of access to health and health information could they have? What about neighborhood access to green spaces? “These are important for overall health, but they are absolutely important for lung health, and issues like poverty disproportionately affect women.”
COPD is not a death sentence
Both DeMeo and Todd emphasized that having COPD does not mean you are condemned to death.
“We can monitor symptoms and monitor quality of life and intervene,” DeMeo said. “When we approach people with COPD with compassion, with empathy, like any other disease, I think people understand that living with COPD and living a full life with COPD is very possible. You should be kind to yourself and take advantage of pulmonary rehabilitation, all preventive therapies, and management of multiple [other] conditions potentially and just live a full life.”
Todd continues to enjoy life, despite some of the restrictions caused by COPD. He makes sure to take his medications and recently started using oxygen at night. “They did a sleep test on me and found that my oxygen really went down at night,” he said. “But while it sucks to have COPD, it’s not a death sentence if you’re proactive and get enough exercise. I still have a very good life. I travel. I hike. “I do a lot of things.”
This educational resource was created with the support of GSK, Regeneron and Sanofi.
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