Sex and gender differences in chronic obstructive pulmonary disease

Gender differences are evident in chronic obstructive pulmonary disease (COPD) pathogenesis, manifestations, and response to therapy. Consequently, a better understanding of the gender-influenced factors in COPD pathobiology can help clinicians to make appropriate decisions surrounding the diagnosis and treatment of women with COPD. COPD is underdiagnosed in women, a fact that may reflect discrepancies in presenting symptom profiles in men and women. Women develop COPD at an earlier age with less aggregate tobacco exposure, suggesting enhanced susceptibility to the local toxic effects of cigarette smoke. Gender-by-smoking and gender-by-genetic interactions may underlie many of the sex-disparate features of COPD presentation and clinical course. This article reviews our current understanding of gender as COPD comorbidity and explores possible underlying mechanisms and clinical implications of gender influences in this complex disorder. Recommendations for adjustments in clinical practice and further research are presented.