Physician Update - Women and COPD: Suddenly Epidemic but Largely Underdiagnosed
Women and COPD: Suddenly Epidemic but Largely Underdiagnosed
Date: June 28, 2013
Until a few years ago, chronic obstructive pulmonary disease (COPD) was thought of only as a disease of middle-aged men. Literature reports of the progressive lung disease most often caused by cigarette smoking were exclusively done in males, and physicians trained into the 1990s were taught that it largely affected men.
But over the last 10 to 15 years, the number of women presenting with COPD has sharply increased, says pulmonologist Enid Neptune. Today, about 60 percent of COPD patients seen at Johns Hopkins and other centers are women.
This rise reflects the large number of women who began smoking during the women's movement, peaking in the 1980s, says Neptune. COPD is one of several consequences, along with lung cancer and cardiovascular problems, that would present 20 to 30 years later.
Thanks to history, however, "physicians are much less likely to make the COPD diagnosis in women," Neptune says. "We want to make sure the pulmonary community understands this is an epidemic."
Compounding the problem, COPD research has been underfunded, says pulmonologist Robert Wise, head of Hopkins' COPD program.
"There has been very little interest from the public in COPD as a women's disease," he says, "even though more women die from COPD than from breast cancer."
With no cure for COPD, Hopkins investigators have taken on a few research projects to better understand the condition. Wise is the principal investigator for two clinical trials, one of which is evaluating the antihypertensive drug losartan as a way to stabilize or improve lung function in people with COPD. In a previous study in mice, led by Neptune, the drug helped prevent or reverse inflammation and lung damage.
Another trial is testing the potential of the broccoli sprout extract sulforaphane to stimulate Nrf2, a molecule that turns on numerous antioxidant and pollutant-detoxifying genes to protect the lungs from cigarette smoke. COPD patients have significantly lower levels of Nrf2 than nonsmokers. Additional studies are planned to explore the mechanisms of sulforaphane to increase bacterial clarance and restore steroid sensitivity in COPD lung cells.
On the basic science side, Neptune wants to model the effects of cigarette smoking in women in an animal model, to identify affected pathways and help with more targeted drug development or smoking cessation programs for women.
Studies have shown that women have a harder time quitting smoking, but when they do, they have greater recovery of lung function. And, says Neptune, "There is no point in time in which you don't get a life expectancy benefit from stopping smoking."
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