Table 2.

Summary of the influence of sex on the prevalence, diagnosis, and outcomes of chronic obstructive pulmonary disease (COPD)

Outcomes	Male	Female
Prevalence	– Historically more prevalent in males by administrative database analysis23 – Prevalence decreasing in the US,24 but still rising in developing countries – Mostly emphysematous phenotype33,34	– Prevalence is higher by self-report, 23,25 and is increasing in females24 – Mostly chronic bronchitis phenotype In the US, the number of women diagnosed annually with emphysema now surpasses that of men as of 201134
Quality of life	– Poor quality of life compared to general population	– Poorer quality of life than men and more intense dyspnea40,44,46
Diagnosis	– More likely to be diagnosed with COPD50,51 – Fewer reports of diagnostic delay or reaching physician	– More likely to be diagnosed with asthma50,51 – More diagnostic delay, difficulty reaching physician, or having adequate time52
Comorbidities	– IHD, arrhythmias, alcoholism, renal failure, cancers more common45,53,54	– Depression, anxiety, osteoporosis, reflux, IBD more common45,53–57
Acute exacerbations and hospitalizations	– Mortality higher after exacerbation, higher average number of hospitalizations per year42,75–77	– Mortality may be lower after exacerbation42,75–77
Responses to treatment options	– More attempts at and more sustained quitting of smoking; nicotine replacement more effective32,59,60 – ICS reduces phlegm more63 – Benefits of LTOT may not be as good as in women – Effects of pulmonary rehabilitation may be more sustained72	– Fewer quit attempts, less sustained quitting, but better improvement in FEV1 with quitting32,59,60 – ICS may not reduce phlegm as well.63 but deterioration may be worse on stopping;65 chronic macrolide therapy may be more effective66 – More emotional and psychosocial benefits from pulmonary rehabilitation73
Mortality	– Declining over last few decades23	– Increasing over last few decades; and predicted to continue to rise;23 more women have died than men from COPD in the US since 200023

Abbreviations: IHD, ischemic heart disease; IBD, inflammatory bowel disease; FEV₁, forced expiratory volume in 1 second; ICS, inhaled corticosteroids; LTOT, long-term oxygen therapy.