Environmental and occupational exposures: do they affect chronic obstructive pulmonary disease differently in women and men?

This workshop summary examines current research that addresses the question: Are women more susceptible than men to the effects of inhaled pollutants, namely those found in work or residential environments? A systematic literature review was performed in preparation for the workshop. A total of 73 recent (since 2000) articles were retrieved reporting on occupational and environmental exposures and their impact on chronic obstructive pulmonary disease, of which only nine provided gender-stratified results. In two mortality studies, results were contrary (one finding increased chronic obstructive pulmonary disease mortality in relation to traffic among elderly women compared with men, the other finding no gender difference). Two other environmental studies suggested small gender differences with slightly greater effect of biomass or traffic-related pollution among women. Four of five occupational studies also found increased effects of workplace pollutant exposure on measures of chronic airflow obstruction or bronchitis symptoms in women; again the differences were small. Preliminary findings from analysis of pooled data from six cross-sectional occupational surveys by our team also indicated increased relative risk for airflow obstruction in relation to work in industrial or service jobs among women compared with men, but only when airflow obstruction was measured using a gender-specific approach to determining the lower limit of normal. Workshop participants identified five key gaps and research needs, including the development of gender-sensitive tools for conducting future research in this area.