The Underdiagnosis of Chronic Obstructive Pulmonary Disease in Women. Another Pending Task?

Abstract

The prevalence of Chronic Obstructive Pulmonary disease (COPD) in various epidemiological studies conducted in Europe is between 5% and 11%, with a higher prevalence in men than in women. This can be explained by the higher prevalence of smoking in males, which is the principal risk factor associated with COPD, at least in industrialised countries.1 However, in recent years we have witnessed an increase in the prevalence of COPD in women, due to their incorporation to smoking in the 1960–1970s in developed countries,2 (incorporation which has been somewhat later in Spain) and the exposure to other risk factors such as the combustion of biomass products, especially in developing countries.3 In fact, in the year 2000 in the United States, mortality due to COPD in women exceeded that in men for the first time.4 From a symptomatic point of view, women with COPD have more dyspnoea, a higher prevalence of anxiety and depression and lower quality of life with respect to men for the same lung function and intensity of smoking, and more often have a chronic bronchitislike phenotype, while males are more likely to have an emphysema phenotype. Furthermore, the loss of lung function that they experience may be greater than in men, and they have more difficulty in quitting smoking.3,4 Despite the increase in the prevalence of COPD in women, underdiagnosis in females is usually greater than in men. A clear example of this underdiagnosis was shown by Chapman et al.5 In their study, they showed that when hypothetical cases of smokers with dyspnoea and cough were presented to Primary Care physicians, in which the only parameters that varied were sex and age, the probability of diagnosing COPD in men was greater than in women (58% vs 42%, P<.05).5 In the study published in this edition of Archivos de Bronconeumologia, Ancochea et al.6 present results on the underdiagnosis of COPD in women in Spain, its regional distribution and determinants, extracted from the EPI-SCAN epidemiological study. In this study, the rate of underdiagnosis in patients with COPD was