Sex and Gender-based Analysis of this topic
Definition
Chronic Obstructive Pulmonary Disease (COPD) is a long-term lung disease that causes the airways of the lungs to be inflamed or become obstructed and includes the diseases chronic bronchitis and emphysema. COPD is characterized by difficulty breathing, wheezing, and/or chronic coughing due to excessive mucous in the lungs. Approximately 90% of cases are caused by smoking[1]. COPD is the fourth leading cause of death among Canadians[2].
Sex Issues
More than 425,000 women have been diagnosed with COPD and female COPD mortality rates are rising at twice the rate compared to breast cancer[3]. It is expected that more women than men will die from COPD in 2007[4]. Steeper COPD mortality rates are expected among women due to both the higher prevalence rates among women and the increase of women in the senior population. Because women have a smaller lung capacity and smaller airways and muscles for breathing, women use a higher fraction of their lung capacity, which results in greater difficulty breathing, or dyspnea, for similar severity of COPD compared to men[5].
Gender Issues
For all age groups other than 75+ years, women have higher prevalence rates, which may be reflective of women’s increased smoking rates post-World War II, women’s greater sensitivity to the harmful components of tobacco smoke, and women’s higher rates of physician visits[6]. However, even though women are more likely to see a physician regarding their COPD symptoms, women are often mis-diagnosed with asthma [7]. Further, women often do not report sputum or phlegm production. COPD treatment recommendations are not followed for women as they are for men. Most notably, women are not adequately screened because physicians continue to treat COPD as a male health issue[8].
Diversity
Currently there exists minimal research on COPD and women and it is expected that COPD is severely under-diagnosed in populations of women who have limited access to healthcare, especially new immigrants and women with low-incomes. For example, there is limited information on the epidemiology and diagnostic issues in Aboriginal, specifically Inuit, Metis, and new immigrant, populations[7]. This lack of information makes it difficult to direct culturally relevant resources to ensure timely diagnosis for these groups.
Critique
COPD is not currently regarded as a major health concern for women. A more comprehensive surveillance system is needed in order to diagnose individuals who are currently unaware that they have COPD, including utilization of health services, such as spirometry, home care, oxygen therapy, and/or pulmonary rehabilitation. For example, the Canadian Community Health Survey only asks if COPD has been diagnosed by a physician, which gives a highly under representative indication of COPD, especially if women are not screened properly.