Aryal Shambhu, Diaz-Guzman Enrique, Mannino David M
Division of Pulmonary, Allergy and Critical Care Medicine, Duke University, Durham, NC, USA.
Division of Pulmonary, Allergy and Critical Care, University of Alabama, Birmingham, AL, USA.
Int J Chron Obstruct Pulmon Dis. 2014 Oct 14;9:1145-54. doi: 10.2147/COPD.S54476. eCollection 2014.
Chronic obstructive pulmonary disease (COPD), one of the most common chronic diseases and a leading cause of death, has historically been considered a disease of men. However, there has been a rapid increase in the prevalence, morbidity, and mortality of COPD in women over the last two decades. This has largely been attributed to historical increases in tobacco consumption among women. But the influence of sex on COPD is complex and involves several other factors, including differential susceptibility to the effects of tobacco, anatomic, hormonal, and behavioral differences, and differential response to therapy. Interestingly, nonsmokers with COPD are more likely to be women. In addition, women with COPD are more likely to have a chronic bronchitis phenotype, suffer from less cardiovascular comorbidity, have more concomitant depression and osteoporosis, and have a better outcome with acute exacerbations. Women historically have had lower mortality with COPD, but this is changing as well. There are also differences in how men and women respond to different therapies. Despite the changing face of COPD, care providers continue to harbor a sex bias, leading to underdiagnosis and delayed diagnosis of COPD in women. In this review, we present the current knowledge on the influence of sex on COPD risk factors, epidemiology, diagnosis, comorbidities, treatment, and outcomes, and how this knowledge may be applied to improve clinical practices and advance research.
慢性阻塞性肺疾病（COPD）是最常见的慢性疾病之一，也是主要的死亡原因，一直以来被认为是男性疾病。然而，在过去二十年中，女性COPD的患病率、发病率和死亡率迅速上升。这在很大程度上归因于女性烟草消费的历史性增长。但性别对COPD的影响很复杂，涉及其他几个因素，包括对烟草影响的易感性差异、解剖学、激素和行为差异以及对治疗的不同反应。有趣的是，患有COPD的非吸烟者更可能是女性。此外，患有COPD的女性更可能具有慢性支气管炎表型，心血管合并症较少，伴有更多的抑郁症和骨质疏松症，并且急性加重的预后更好。从历史上看，女性COPD的死亡率较低，但这种情况也在发生变化。男性和女性对不同治疗的反应也存在差异。尽管COPD的情况在不断变化，但医疗服务提供者仍然存在性别偏见，导致女性COPD的诊断不足和诊断延迟。在本综述中，我们介绍了关于性别对COPD危险因素、流行病学、诊断、合并症、治疗和结局的影响的现有知识，以及如何应用这些知识来改善临床实践和推进研究。
