Diagnosis and treatment considerations for women with COPD

Division of Pulmonary-Critical Care Medicine, The Bay Pines Veterans Affairs Healthcare System, University of South Florida, Tampa, FL 33744, USA.
International Journal of Clinical Practice (Impact Factor: 2.57). 04/2009; 63(3):486-93. DOI: 10.1111/j.1742-1241.2008.01987.x
Source: PubMed

ABSTRACT The worldwide prevalence of chronic obstructive pulmonary disease (COPD) is growing faster in women than in men. Over the past two decades, COPD-related mortality rates have also grown faster in women, and since the year 2000 more women than men have died from COPD. The greater prevalence of COPD and related mortality reported for men in earlier epidemiological studies may be due to under-diagnosis of women. In addition, factors such as prevalence of symptoms, triggering stimuli, response to treatment, susceptibility to smoking, frequency of exacerbations, impairment in quality of life response to oxygen therapy, presence of malnutrition, airway hyper-responsiveness and depression are more frequently seen in women with COPD. Despite these differences, the current guidelines for the diagnosis and treatment of men or women with COPD are the same. It is important for healthcare professionals to recognise the gender differences in patients with COPD to optimise assessment, monitoring and treatment of this disease. This article reviews the clinical differences between men and women with COPD, current treatment guidelines and its implications for improvement in the management of women with COPD.

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Available from: Kenneth R Chapman, Dec 19, 2014
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    • "In previous studies (Cote & Chapman, 2009; van Ede et al., 1999), the prevalence of depression among patients with COPD was within the range of 6–42%. Most studies included patients with moderate to severe COPD. "
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    ABSTRACT: Objective: There have been few studies examining the relationship between chronic obstructive pulmonary disease (COPD) and psychiatric morbidity in Hong Kong. This study aimed to examine the prevalence of depressive disorders (major depression, dysthymia and adjustment disorder with depressed mood) in Chinese patients with COPD and explore their demographic and clinical correlates. Method: A total of 146 patients aged 50 years and above with COPD and 220 age and gender matched control subjects without COPD formed the study sample. Data of demographic and clinical characteristics were collected by a form designed for this study. Activity of daily living was assessed by the Instrumental Activities of Daily Living Scale and life events were evaluated by the Life Event Scale. Depressive disorders were determined using the Chinese version of the Structured Clinical Interview for DSM-IV. Results: The point prevalence of DSM-IV depressive disorders in patients with COPD and controls were 15.1% and 3.6%, respectively. Multivariate analyses revealed that female sex and severe impairment in daily activity functioning were independently associated with depressive disorders. Only 22.7% of the depressed COPD patients had consulted psychiatrists in the past three months. Conclusion: Depressive disorders are significantly higher in COPD patients than controls. The low percentage of depressed patients with COPD seeking psychiatric treatment suggests that there is an unmet need in the psychiatric care of COPD patients.
    Aging and Mental Health 11/2013; 18(5). DOI:10.1080/13607863.2013.856862 · 1.75 Impact Factor
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    • "The biological explanation for this gender difference is largely unknown. There are, however, differences between the clinical manifestation and pathophysiology of lung disease in men and women [37,38]. Women with COPD have more dyspnea, anatomically smaller airway lumens with disproportionately thicker airway walls and less extensive emphysema. "
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    ABSTRACT: Low lung function is associated with increased morbidity and mortality. It is therefore of interest to identify biomarkers that are associated with impaired lung function. The aim of the study was to analyse associations of biomarkers and combinations of biomarkers with lung function in an elderly general population. Lung function (FEV1 and FVC) and a panel of 15 inflammatory markers from blood samples were analysed in 888 subjects aged 70 years. Biomarkers included cytokines, chemokines, adhesion molecules, C-reactive protein (CRP) and leukocyte count. Leukocyte count and CRP were independently associated with FEV1 after adjustments for other inflammatory markers, sex, BMI, current smoking and pack-years of smoking. In a similar model, leukocyte count and vascular cell adhesion protein 1(VCAM-1) were the biomarkers that were significantly associated with FVC. Subjects that had both leukocyte count and CRP in the lowest tertile had a FEV1 that was 9 % of predicted higher than subjects with leukocyte count and CRP in the highest tertile (103+/-16 vs. 94+/-21 % of predicted, p=0.0002) (mean+/-SD). A difference of 8 % of predicted in FVC was found between subjects with leukocyte count and VCAM-1 in the lowest and highest tertiles, respectively (106+/-18 vs. 98+/-19 % of predicted, p=0.002). leucocyte count, CRP and VCAM-1 were found to relate to poorer lung function. A dose related association was found for the combination leukocyte count and CRP towards FEV1 and leukocyte and VCAM-1 towards FVC. This indicates that combination of two biomarkers yielded more information than assessing them one by one when analysing the association between systemic inflammation and lung function.
    BMC Geriatrics 08/2013; 13(1):82. DOI:10.1186/1471-2318-13-82 · 1.68 Impact Factor
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    • "However, some diseases disproportionately affect women. For example, there is a higher prevalence of diseases such as chronic obstructive pulmonary disease (COPD) and autoimmune disorders among women (Fairweather et al., 2008; Cote and Chapman, 2009), and women are more likely to suffer more severe symptoms and higher mortality from stroke and diabetes (Moriyama, 1984; Reeves et al., 2008; Turtzo and McCullough, 2008; Appelros et al., 2009). "
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    ABSTRACT: In most modern populations, there are sex differentials in morbidity and mortality that favor women. This study addresses whether such female advantages existed to any appreciable degree in medieval Europe. The analyses presented here examine whether men and women with osteological stress markers faced the same risks of death in medieval London. The sample used for this study comes from the East Smithfield Black Death cemetery in London. The benefit of using this cemetery is that most, if not all, individuals interred in East Smithfield died from the same cause within a very short period of time. This allows for the analysis of the differences between men and women in the risks of mortality associated with osteological stress markers without the potential confounding effects of different causes of death. A sample of 299 adults (173 males, 126 females) from the East Smithfield cemetery was analyzed. The results indicate that the excess mortality associated with several osteological stress markers was higher for men than for women. This suggests that in this medieval population, previous physiological stress increased the risk of death for men during the Black Death to a greater extent than was true for women. Alternatively, the results might indicate that the Black Death discriminated less strongly between women with and without pre-existing health conditions than was true for men. These results are examined in light of previous analyses of East Smithfield and what is known about diet and sexually mediated access to resources in medieval England.
    American Journal of Physical Anthropology 10/2010; 143(2):285-97. DOI:10.1002/ajpa.21316 · 2.38 Impact Factor
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