Ohar Jill, Fromer Leonard, Donohue James F
Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University Health Sciences, Medical Center Boulevard, Winston Salem, NC 27157, USA.
Prim Care Respir J. 2011 Dec;20(4):370-8. doi: 10.4104/pcrj.2011.00070.
Chronic obstructive pulmonary disease (COPD) has historically been considered a disease of older, white, male smokers, as illustrated in Frank Netter's classic images of the 'pink puffer' and 'blue bloater'. However, women may be more susceptible to COPD than men, and the disease course may be reflective of that increased susceptibility. From a review of epidemiological data of COPD, we found differences in the way men and women present with COPD symptoms, a bias in the way COPD symptoms are treated in men and women, and differences in susceptibility to airway obstruction based on age, sex, and smoking history. These data show that classic stereotypes of COPD - including male predominance - should be abandoned, and that there are not two but multiple COPD phenotypes, which are characterised by differences between women and men in susceptibility, symptoms, and disease progression. These differences impact on physician perception. Although further research into this concept is needed, the differences we found should prompt, in the short term, changes in the way (and in whom) COPD is evaluated, diagnosed, and treated; in the long term, these differences should prompt research into the prognosis of COPD based on sex differences.
慢性阻塞性肺疾病（COPD）在历史上一直被认为是老年白人男性吸烟者的疾病，正如弗兰克·奈特（Frank Netter）关于“粉 puff 者”和“蓝肿者”的经典图像所示。然而，女性可能比男性更容易患 COPD，并且疾病进程可能反映出这种易感性增加。通过对 COPD 流行病学数据的回顾，我们发现男性和女性出现 COPD 症状的方式存在差异，在治疗男性和女性 COPD 症状的方式上存在偏差，以及基于年龄、性别和吸烟史的气道阻塞易感性差异。这些数据表明，COPD 的经典刻板印象——包括男性占主导——应该被摒弃，并且不是有两种而是有多种 COPD 表型，其特征是女性和男性在易感性、症状和疾病进展方面存在差异。这些差异会影响医生的认知。尽管需要对这一概念进行进一步研究，但我们发现的这些差异应在短期内促使改变评估、诊断和治疗 COPD 的方式（以及对象）；从长远来看，这些差异应促使基于性别差异对 COPD 的预后进行研究。
