COPD in Women: Key Findings

COPD in Women Increasing More Rapidly Worldwide

Background: COPD in women receives little attention as a health issue even though more women die of COPD each year than of breast cancer and lung cancer combined. The general perception that COPD is a disease of older men is outdated. Throughout the world, COPD is increasing more rapidly in women than in men. Since 2000, more women than men in the United States die of COPD.

Dr. Jenkins has written about COPD in women

Professor Christine Jenkins

Review: Dr. Christine Jenkins of Sydney, Australia, and co-authors described the impact of female sex on COPD in a review article in the March 2017 issue of Chest, volume 151; pages 686-696.

Key Findings about COPD in Women: 1. For the same amount of smoking or exposure to irritants in the air, women are more susceptible to developing COPD. 2. The reasons for smoking may differ between sexes. Dr. Jenkins proposed that female empowerment through tobacco smoking and weight control are likely two reasons that women smoke. 3. Women with COPD are generally younger, smoke less, and have a lower body weight for their height than men. 4. Women tend to have more shortness of breath than men for the same level of breathing tests results. 5. In a 3-year study in the US, it was found that women had more frequent flare-ups (exacerbations) of COPD than men.

Female with COPD

How Does COPD Affect Women? In many studies it was noted that women have poorer health status and quality of life compared with men. Women with COPD report higher levels of anxiety and depression than men with COPD which adds to the burden of the disease in women.

Treating Women with COPD: Smoking cessation is an important treatment for anyone with COPD. However, women may be less successful with long-term smoking cessation than men, especially with nicotine replacement therapy. Current evidence shows that inhaled bronchodilators work the same in women as in men.

COPD in Women

Summary: The authors concluded that it is important to raise awareness of COPD in women and to develop new strategies to prevent the disease.  They also emphasized the need for educational programs for women with COPD and their families to manage their disease better.

My Comments: I offer the following two general impressions based on my pulmonary practice, although I have no explanation for these observations. 1. Women with COPD seem more motivated to “get better” and use prescribed inhalers as recommended. 2. Women are more likely than men to actually participate in pulmonary rehabilitation programs.

 

Course of Depression in COPD

Three Year Follow-up of Depression in COPD Patients

Background: Depression occurs in 17% of adults living in the United States at some time during their life.  It is more common is those with COPD.  In two recent studies, the prevalence of clinically significant depressive symptoms was 42 – 57%.

What does depression feel like? Here are some symptoms:

  • A depressed mood during most of the day, particularly in the morning
  • Loss of energy
  • Feelings of worthlessness or guilt
  • Impaired concentration, indecisiveness
  • Trouble sleeping or excessive sleeping almost every day
  • Markedly diminished interest or pleasure in almost all activities nearly every day
  • Recurring thoughts of death or suicide
  • A sense of restlessness or being slowed down
  • Significant weight loss or gain
Man sitting alone on bench

One image of depression: man sitting alone on bench

 

Study: Yohannes and colleagues reported on the course of depression over 3 years in the ECLIPSE study of those with COPD.  The article was published on-line in the journal CHEST.

Chest. 2016 Jan 5. pii: S0012-3692(15)00440-7. doi: 10.1016/j.chest.2015.10.081. [Epub ahead of print]

At the start of the study, patients were split into groups based on depression score (less than 16 and 16 or greater) and whether they were taking antidepressants (yes or no).

 

Results: 1,580 individuals completed the 3-year follow-up. Of these:

  1. 55% were classified as never depressed
  2. 24% were classified as persistently depressed
  3. 14% developed new onset of depression during the study
  4. 7% had their depression clear up (resolve)

Being a female and having a history of a stroke were associated with a substantial increase in the odds of persistent depression. The odds of new onset increased with worse health status and moderate to severe breathing difficulty.

During follow-up, those with persistent or new-onset depression had more worsening of breathing (an exacerbation) and a greater loss in performance based on distance walked in 6 minutes.

de-pression-48811290591547Hxs

My Comments:  Breathing difficulty can be quite frustrating especially when it limits your ability to do daily activities. This can affect mood and cause feelings of low energy and wanting to “give up.” In my practice, I have observed improvements in mood and interest in life in individuals with COPD who are started on new or better medications that make it easier to breathe.  This can have a huge impact on the person’s outlook and desire to be active.

I encourage those individuals with COPD to discuss any depressed feelings  with their health care provider. A trial of a new bronchodilator medication may help with breathing and thereby improve mood. Physical exercise as part of a pulmonary rehabilitation program may also improve your outlook and how your feel. Medication that treats depression is another consideration. Referral to a psychologist or psychiatrist may also be beneficial.