Women manifest more severe COPD symptoms across the life course

Dawn L DeMeo,1 Sreeram Ramagopalan,2 Abhishek Kavati,3 Ashok Vegesna,3 Meilan K Han,4 Anthony Yadao,5 Teresa K Wilcox,2 Barry J Make6 On behalf of COPDGene Investigators 1Channing Division of Network Medicine and the Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; 2Real-World Evidence, Evidera, London, UK; 3US Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 4Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA; 5US Clinical Development and Medical Affairs, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 6Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO, USA Background: Previous studies suggest that gender differences exist in COPD diagnosis and symptoms; these differences may be more pronounced in younger adults. Our objective was to explore age-associated gender differences across a range of COPD severities. Materials and methods: A total of 4,484 current and former smokers with COPD from the Genetic Epidemiology of COPD cohort were investigated using regression modeling to explore the association between gender, age, disease severity, and the contributing elements of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification system (symptoms, exacerbation risk, airflow limitation). Results: The age–gender interaction was observed across multiple age categories. Compared to men with COPD, younger women with COPD had a greater likelihood of more severe dyspnea, airflow limitation, greater risk for exacerbations, and categorization in GOLD groups B and D. These differences were less pronounced in older women with COPD. However, older women remained more likely to experience severe dyspnea and to manifest more severe COPD (B vs A) than older men, despite lower pack-years of smoking. Conclusion: These data demonstrate the significant symptom burden of COPD in women, especially younger women. More research is needed to understand the pathogenesis of increased severity of COPD in women and to develop gender-targeted clinical assessment and management approaches to improve outcomes for women and men with COPD at all ages. Keywords: COPD, gender, age, symptoms, exacerbation