Chronic Obstructive Pulmonary Disease in women needs a different clinical management

The words sex and gender often misunderstood, but have specific meaning when it comes to their effects on lung disease. Ample evidence is now available that sex and gender affect the incidence, susceptibility, presentation, diagnosis, and severity of many lung diseases.

There is a growing body of evidence to indicate that Chronic Obstructive Pulmonary Disease (COPD) affects men and women differently, and that men and women patients with COPD require different clinical management. Women are often underdiagnosed or misdiagnosed, partly because of poorly understood sex differences, but also because of cultural biases.

A recent review reported that CELSR1, a gene involved in fetal lung development, was expressed more among women than among men and that a single nucleotide polymorphism in the gene was associated with COPD among women smokers, but not among men smokers.

The study has been published in Chest Journal.

The finding points to a potential risk locus for COPD in women, and could help shed light on sexual dimorphism in COPD, Hardin and colleagues said. In contrast to sex, gender is more of a psychosocial construct which is said to impact how diseases manifest themselves, how they are potentially managed, and what outcomes might occur for that particular disease.

Researchers found that clinical presentation might differ as well, such as higher number of exacerbations experienced by women with COPD and greater cardiovascular morbidity in women with sleep-disordered breathing. In addition, response to therapy and medication safety also differed by sex, and yet, pharmacogenomic factors often are not addressed adequately in clinical trials. Various aspects of lung and sleep biology and pathobiology are impacted by female sex and female reproductive transitions.

Differential gene expression or organ development can be impacted by these biological differences. Understanding these differences is the first step in moving toward precision medicine for women. This article is a state-of-the-art review of specific effects of sex and gender focused on epidemiology, disease presentation, risk factors, and management of lung diseases.

Pathobiological mechanisms explaining sex differences in these diseases are beyond the scope of this article. Researchers reviewed the recent literature and focus on recent guidelines about using sex and gender in research. They also reviewed sex and gender differences in lung diseases.

Reference: https://doi.org/10.1016/j.chest.2022.03.006