Retired paralegal Patti Todd was devastated to learn she had COPD when she was in her 40s. She’d been living for years with asthma, but hearing she had COPD was a blow. She was afraid the diagnosis would affect her active lifestyle. “But the doctor explained, the less you do, the less you’re going to want to do,” she said. “Do as much as you can to push yourself. Don’t just do the stuff you’re comfortable with.” So Todd got a step tracker and began getting in 10,000 steps a day and staying active. Her activity has dropped over time, but she’s still trying to do as much as she can.
COPD, short for chronic obstructive pulmonary disease, is the sixth leading cause of death in the U.S. and fourth worldwide, affecting people in rural areas the most. It’s not just one disease, but a collection of them. The most common forms of COPD are emphysema and chronic bronchitis. Asthma, what Todd had, can overlap and lead to COPD.
Historically, people have thought of lung disease as affecting mostly men, but they’re wrong. Lung diseases, like COPD, hit women, and they hit hard. The death rate among men with COPD has been steady since the mid-1980s, but has almost tripled among women, with more women dying than men.
Smoking makes women more vulnerable to COPD
Smoking, a major risk factor for COPD, is stronger among women. “For every cigarette smoked, women tend to get more severe lung disease at an earlier age,” explained Dawn DeMeo, M.D., MPH, a pulmonary/critical care specialist and associate professor of medicine at Harvard Medical School. “Before the 1960s, women smoking was a socially contentious issue.” To encourage smoking, cigarette companies targeted beauty, fitness and finding your voice as a woman. This resulted in millions of women taking up the habit. And now, many of those women are living with severe COPD.
Todd stopped smoking before her diagnosis. “I smoked from around 15 and I quit around 40, before I was diagnosed with COPD. It was about six years later I was diagnosed and it was really shocking to me.” Todd thought that by quitting smoking, her lung damage wouldn’t progress. “But it just kept getting worse.”
Smoking isn’t the only risk factor for COPD among women, though. Almost 3 out of 10 women with COPD never smoked, compared to under 1 in 10 men. “Some of the risk factors amongst women are exposure to biomass fuel used for cooking, other occupational exposures and genetic family history,” DeMeo said. While these biofuels might not be used in the U.S., some women who immigrate to North America may have been exposed to them from childhood, while their lungs were still forming.
Women are more vulnerable to airway injury because their airways tend to be smaller, and the changes in hormones that come with menopause may also have a role. Some studies are showing early menopause can increase a woman’s risk of developing COPD, as can other reproductive factors, like age when you got your first period and the number of pregnancies you’ve had.
Different COPD symptoms and other conditions
Many health conditions, like heart disease, cause different symptoms in women, and this happens with COPD too. “Symptomatically, women may describe more cough and phlegm, potentially present with more shortness of breath,” DeMeo said. Women’s symptoms are more severe and they have more flare-ups. “But I think one of the likely striking issues relates to the age of presentation and the symptoms, and how long those symptoms may have gone unaddressed and undiagnosed over time.” Women experience symptoms earlier and for longer before they’re diagnosed.
According to research, women with COPD are also more likely to have depression, anxiety and osteoporosis, the thinning of the bones. Frailty is also something to be concerned about, DeMeo said. “That’s an area of ongoing research, but an opportunity for intervention. This is where [it’s important to make] sure you know the woman with COPD has access to other providers to help with nutrition, to stave off weight loss and weight gain, depending on their 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 education level, and their household income can also impact their risk for COPD. Research shows that COPD rates are higher among people in rural areas and lower among people who finished high school and who had higher monthly household incomes. Also, people with COPD in lower income groups get worse faster compared to those in higher income brackets. DeMeo points out there are several reasons for this. “Do they live in a food desert? What kind of access to health and health information might they have? What about neighborhood access to green space? These are important for health in general, but they’re absolutely important to lung health, and issues like poverty disproportionately impact women.”
COPD isn’t a death sentence
Both DeMeo and Todd stressed that having COPD doesn’t mean you have a death sentence.
“We can manage symptoms and manage quality of life and intervene,” DeMeo said. “When we approach people with COPD with compassion, with empathy, like any other disease, then I think people understand that living with COPD and living a full life with COPD is very possible. You need to be gentle on yourself and just avail yourself of pulmonary rehabilitation, all of the preventive therapies, managing multiple [other] conditions potentially and just lead a full life.”
Todd continues to enjoy life, despite some of the restrictions caused by COPD. She makes sure to take her medications and she recently started using oxygen at night. “They did a sleep test and found my oxygen was really dropping at night,” she said. “But although COPD is horrible to have, it’s not a death sentence if you’re proactive about getting enough exercise. I’m still having a very fine life. I travel. I hike. I do lots of things.”
This educational resource was created with support from GSK, Regeneron and Sanofi.
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