Article information
Resumen
La prevalencia de la enfermedad pulmonar obstructiva crónica (EPOC) se está incrementando en todo el mundo, fundamentalmente a expensas del aumento en las mujeres.
En los países desarrollados, la EPOC en la mujer es consecuencia, principalmente, de la exposición al humo de tabaco, y en los países en vías de desarrollo, a la inhalación de los productos de combustión de la biomasa. El infradiagnóstico de la EPOC es más común en las mujeres, ya que ha sido, clásicamente, asociada al sexo masculino. Además, la enfermedad presenta aspectos diferenciales en las mujeres como son: mayor expresión de los aspectos perceptivos (disnea y calidad de vida relacionada con la salud), elevada prevalencia de desnutrición, alta prevalencia de ansiedad y depresión y un patrón de distribución del enfisema diferente al de los varones.
Una mejor caracterización fenotípica de la EPOC en la mujer nos permitirá abordar, de modo apropiado, su impacto en el sistema sanitario y diseñar estrategias terapéuticas más individualizadas.
Palabras clave:
EPOC
Sexo
Aspectos diferenciales
Abstract
The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide, mainly due to the increase in women. In developed countries, COPD in women is mainly a result of exposure to tobacco smoke and in developing countries to inhalation of biomass combustion products.
Underdiagnosis of COPD is more common in women since this disease has classically been associated with men. Moreover, COPD in women shows certain differential features, such as a greater expression of aspects related to perception (dyspnea and health-related quality of life), a high prevalence of malnutrition, anxiety and depression, and a distinct distribution of emphysema from that in men. Better phenotypical characterization of COPD in women would allow its impact on the health system to be more accurately evaluated and more individualized therapeutic strategies to be designed.
Keywords:
COPD
Sex
Differential features
Full text is only aviable in PDF
Bibliografía
[1.]
A. Jamal, E. Ward, Y. Hao, M. Thun.
Trends in the leading causes of death in the United States, 1970-2002.
JAMA, 294 (2005), pp. 1255-1259
[2.]
Centers for Disease Control and Prevention Cigarette smoking among adults– United States. JAMA. 1995;273:369-70.
[3.]
D.R. Gold, X. Wang, D. Wypij, F.E. Speizer, J.H. Ware, D.W. Dockery.
Effects of cigarette smoking on lung function in adolescent boy and girls.
N Engl J Med, 335 (1996), pp. 931-937
[4.]
D.M. Mannino, D.M. Homa, L.J. Akinbami, E.S. Ford, S.C. Redd.
Chronic Pulmonary Disease Surveillance- United States, 1971-2000.
MMWR, 51 (2002), pp. SS1-16
[5.]
D.M. Mannino.
COPD: epidemiology, prevalence, morbidity and mortality, and disease heterogeneity.
Chest, 121 (2002), pp. 121S-126S
[6.]
E. Prescott, A.M. Bjerg, P.K. Andersen, P. Lange, J. Vestbo.
Gender diferences in smoking effects on lung function and risk of hospitalization for COPD: results from de Danish longitudinal population study.
Eur Respir J, 10 (1997), pp. 822-827
[7.]
K.R. Chapman, D.P. Tashkin, D. Pye.
Gender Bias in the Diagnosis of COPD.
Chest, 119 (2001), pp. 1691-1695
[8.]
M. Miravitlles, C. De la Roza, K. Naberan, M. Lamban, E. Gobartt, A. Martín, et al.
Attitudes toward the diagnosis of chronic obstructive pulmonary disease in primary care.
Arch Bronconeumol, 42 (2006), pp. 3-8
[9.]
Bruce N, Pérez-Padilla R, Albalak R. The health effects of indoor air pollution exposure in developing countries. Geneva, Switzerland: World Health Organization; 2002. Publication No. WHO(2002)/SDE/OEH/02.05, Geneva Blanc PD.
[10.]
M.R. Becklake, F. Kauffmann.
Gender differences in airway behaviour over the human life span.
Thorax, 54 (1999), pp. 1119-1138
[11.]
X. Xu, B. Li, L. Wang.
Gender difference in smoking effects on adult pulmonary function.
Eur Respir J, 7 (1994), pp. 477-483
[12.]
X. Xu, S.T. Weiss, B. Rijcken, J.P. Shouten.
Smoking, changes in smoking habits, and rate of decline in FEV1: new insights into gender differences.
Eur Resp J, 7 (1994), pp. 1056-1061
[13.]
N.R. Anthonisen.
Lessons from Lung Health Study.
Proc Am Thorac Soc, 1 (2004), pp. 143-145
[14.]
J. Zieliñski, M. Bednarek, The Know the Age of Your Lung Study Group.
Early Detection of COPD in a High-Risk Population Using Spirometric Screenig.
Chest, 119 (2001), pp. 731-736
[15.]
P.D. Blanc.
The role of household exposure in lung disease among women.
Eur Respir Mon, 25 (2003), pp. 118-130
[16.]
A. Ramirez-Venegas, R.H. Sansores, R. Perez-Padilla, J. Regalado, A. Velazquez, C. Sanchez, et al.
Survival of patients with chronic obstructive pulmonary disease due to biomass smoke and tobacco.
Am J Respir Crit Care Med, 173 (2006), pp. 393-397
[17.]
K. Nishimura, T. Izumi, M. Tsukino, T. Oga.
Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD.
Chest, 121 (2002), pp. 1434-1440
[18.]
PAARC. Group Coopératif.
Pollution atmosphérique et affections respiratoires chroniques ou á répétition.
Bull Eur Physiopathol Respir, 18 (1982), pp. 87-99
[19.]
J.P. De Torres, C. Casanova, C. Hernandez, J. Abreu, A. Aguirre-Jaime, B.R. Celli.
Gender and COPD in patients attending a pulmonary clinic.
Chest, 128 (2005), pp. 2012-2016
[20.]
J.P. De Torres, C. Casanova, A. Montejo de Garcini, A. Aguirre-Jaime, B.R. Celli.
Gender and respiratory factors associated with dyspnea in chronic obstructive pulmonary disease.
Respir Res, 8 (2007), pp. 18
[21.]
A.G. Gift, C.E. Shepard.
Fatigue and other symptoms in patients with chronic obstructive pulmonary disease: do women and men differ?.
JOGNN, 28 (1999), pp. 201-208
[22.]
B. Leynaert, J. Bousquet, C. Henry, R. Liard, F. Neukirch.
Is bronchial hyperresponsiveness more frequent in women than in men? A population based study.
Am J Respir Crit Care Med, 156 (1997), pp. 1413-1420
[23.]
R.E. Kanner, J.E. Connet, D.A. Murray, A.S. Buist, W.W. Lee, D.P. Tashkin, et al.
Gender difference in airway hyperresponsiveness in smokers with mild COPD. For the Lung Health Study.
Am J Respir Crit Care Med, 150 (1994), pp. 956-961
[24.]
G.E. Silva, D.L. Sherrill, S. Guerra, R.A. Barbee.
Asthma as a Risk Factor for COPD in a Longitudinal Study.
Chest, 126 (2004), pp. 59-65
[25.]
G.C. Donaldson, T.A. Seemungal, I.S. Patel, A. Bhowmik, T.M. Wilkinson, J.R. Hurst, et al.
Airway and systemic inflammation and decline in lung function in patients with COPD.
Chest, 128 (2005), pp. 1995-2004
[26.]
ATS Statement.
Guidelines for the Six-Minute Walk Test.
Am J Respir Crit Care Med, 166 (2002), pp. 111-117
[27.]
T. Troosters, R. Gosselink, M. Decramer.
Six Minute Walking Distance In Elderly Normal Subjects.
Eur Respir J, 14 (1999), pp. 270-274
[28.]
D.G. Parr, B.C. Stoel, J. Stolk, R.A. Stockley.
Validation of computed tomographic lung densitometry for monitoring emphysema in alpha1-antitrypsin deficiency.
Thorax, 61 (2006), pp. 485-490
[29.]
F.J. Martinez, J.L. Curtis, F. Sciurba, J. Mumford, N.D. Giardino, G. Weinmann, et al.
Gender Differences in Severe Pulmonary Emphysema.
Am J Respir Crit Care Med, 176 (2007), pp. 243-252
[30.]
M.T. Dransfield, G.R. Washko, M.G. Foreman, R.S.J. Estepar, J. Reilly, W.C. Bailey.
Gender differences in the severity of CT emphysema in COPD.
Chest, 132 (2007), pp. 464-470
[31.]
G. Mair, J.J. Miller, D. McAllister, J. Maclay, M. Connell, J.T. Murchison, et al.
Computed tomographic emphysema distribution: relationship to clinical features in a cohort of smokers.
Eur Respir J, 33 (2009), pp. 536-542
[32.]
C. Casanova, C. Cote, J.P. De Torres, A. Aguirre-jaime, J.M. Marin, V. Pinto-Plata, et al.
The Inspiratory to Total Lung Capacity Ratio Predicts Mortality in Patients with COPD.
Am J Respir Crit Care Med, 171 (2004), pp. 591-597
[33.]
J.P. De Torres, C.G. Cote, M.V. López, C. Casanova, O. Díaz, J.M. Marin, et al.
Sex differences in mortality in patients with COPD.
Eur Respir J, 33 (2009), pp. 528-535
[34.]
A.M. Schols, J. Slagen, L. Volovics, E.F.M. Wouters.
Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 15 (1998), pp. 1791-1797
[35.]
A.M. Schols, E.F. Wouters, P.B. Soeters, K.R. Westerterp.
Body composition by bioelectricalimpedance analysis compared with deuterium dilution and skinfold anthropometry in patients with chronic obstructive pulmonary disease.
Am J Clin Nutr, 53 (1991), pp. 421-424
[36.]
M.A. Vermeeren, E.C. Creutzberg, A.M. Schols, D.S. Postma, W.R. Pieters, A.C. Roldaan, COSMIC Study Group, et al.
Prevalence of nutritional depletion in a large out-patient population of patients with COPD.
Respir Med, 100 (2006), pp. 1349-1355
[37.]
Gender differences in emergency department patients with chronic obstructive pulmonary disease exacerbation. Acad Emerg Med. 2005;12:1173-9.
[38.]
C.L. Tsai, S. Clark, R.K. Cydulka, B.H. Rowe, C.A. Camargo Jr.
Factors associated with hospital admission among emergency department patients with chronic obstructive pulmonary disease exacerbation.
Acad Emerg Med, 14 (2007), pp. 6-14
[39.]
M.H. Kollef, J.D. O’Brien, P. Silver.
The impact of gender on outcome from mechanical ventilation.
Chest, 111 (1997), pp. 434-441
[40.]
L.M. Osman, D.J. Godden, J.A.R. Friend, J.S. Legge, J.G. Douglas.
Quality of life and hospital re-admission in patients with chronic obstructive pulmonary disease.
Thorax, 52 (1997), pp. 67-71
[41.]
M. Ferrer, J. Alonso, L. Prieto, V. Plaza, E. Monso, R. Marrades, et al.
Validity and realiability of the Spanish version of the St George's Respiratory Questionnaire.
Eur Respir J, 9 (1996), pp. 1160-1166
[42.]
M. Tsukino, K. Nishimura, A. Ikeda, H. Koyama, M. Mishima, T. Izumi.
Physiologyc factors that determine the Health-Related Quality of Life in patients with COPD.
Chest, 110 (1996), pp. 896-903
[43.]
J. Larson, J. Kirchgessner, J. McCutcheon.
Quality of Life in chronic obstructive pulmonary disease: Gender differences (Abstract).
Amer J Respir Crit Care Med, 157 (1998), pp. A869
[44.]
J.P. De Torres, C. Casanova, C. Hernández, J. Abreu, A. Montejo de Garcini, A. Aguirre-Jaime, et al.
Gender associated differences in determinants of quality of life in patients with COPD: a case series study.
Health Qual Life Outcomes, 4 (2006), pp. 72
[45.]
A. Agusti.
Systemic effects of chronic obstructive pulmonary disease.
Proc Am Thorac Soc, 2 (2005), pp. 367-370
[46.]
P. Almagro, F. López García, F. Cabrera, L. Montero, D. Morchón, J. Díez, J. Soriano, GRupo Epoc De La Sociedad EspañOla De Medicina Interna.
Comorbidity and gender-related differences in patients hospitalized for COPD. The ECCO study.
Respir Med, 104 (2010), pp. 253-259
[47.]
V.S. Fan, S.D. Ramsey, N.D. Giardino, B.J. Make, C.F. Emery, P.T. Diaz, National Emphysema Treatment Trial (NETT) Research Group, et al.
Sex, depression, and risk of hospitalization and mortality in chronic obstructive pulmonary disease.
Arch Intern Med, 167 (2007), pp. 2345-2353
[48.]
F. Di Marco, M. Verga, M. Reggente, F. Maria Casanova, P. Santus, F. Blasi, et al.
Anxiety and depression in COPD patients: The roles of gender and disease severity.
Respir Med, 100 (2006), pp. 1767-1774
[49.]
T.P. Ng, M. Niti, W.C. Tan, Z. Cao, K.C. Ong, P. Eng.
Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life.
Arch Intern Med, 167 (2007), pp. 60-67
[50.]
S. Ben-Zaken Cohen, P.D. Paré, S.F. Paul Man, D.D. Sin.
COPD and Lung Cancer in women: examining sex differences in cigarette smoke metabolism.
Am J Respir Crit Care Med, 176 (2007), pp. 113-120
[51.]
J.E. Connett, R.P. Murray, A.S. Buist, R.A. Wise, W.C. Bailey, P.G. Lindgren, Lung Health Study Research Group, et al.
Changes in smoking status affect women more than men: results of the Lung Health Study.
Am J Epidemiol, 157 (2003), pp. 973-979
[52.]
J.K. Singleton, R.F. Levin, H.R. Feldman, M. Truglio-Londrigan.
Evidence for smoking cessation: Implications for gender-specific strategies.
Worldviews Evid Based Nurs, 2 (2005), pp. 63-74
[53.]
D.E. Goodman, E. Israel, M. Rosenberg, R. Johnston, S.T. Weiss, J.M. Drazen.
The influence of age, diagnosis, and gender on proper use of metered-dose inhalers.
Am J Respir Crit Care Med, 150 (1994), pp. 1256-1266
[54.]
J. Vestbo, J.B. Soriano, J.A. Anderson, P. Calverley, R. Pauwels, P. Jones, TRISTAN Study Group.
Gender does not influence the response to the combination of salmeterol and fluticasone propionate in COPD.
Respir Med, 98 (2004), pp. 1045-1050
[55.]
J.B. Soriano, D.D. Sin, X. Zhang, P.G. Camp, J.A. Anderson, N.R. Anthonisen, et al.
A pooled analysis of FEV1 decline in COPD patients randomized to inhaled corticosteroids or placebo.
Chest, 131 (2007), pp. 682-689
[56.]
A.L. Ries, G.S. Bauldoff, B.W. Carlin, R. Casaburi, C.F. Emery, D.A. Mahler, et al.
Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines.
Chest, 131 (2007), pp. 4S-42S
[57.]
C.G. Cote, B.R. Celli.
Pulmonary rehabilitation and the BODE index in COPD.
Eur Respir J, 26 (2005), pp. 630-636
[58.]
C.G. Foy, J. Rejeski, M.J. Berry, D. Zaccaro, C.M. Woodard.
Gender moderates the effects of exercise therapy on health- related quality of life among COPD patients.
Chest, 119 (2001), pp. 70-76
[59.]
H. Paz-Diaz, M. Montes de Oca, J.M. Lopez, B.R. Celli.
Pulmonary rehabilitation improves depression, anxiety, dyspnea and health status in patients with COPD.
Am J Phys Med Rehabil, 86 (2007), pp. 30-36
[60.]
K. Miyamoto, A. Aida, M. Nishimura, M. Aiba, S. Kira, Y. Kawakami.
Gender effect on prognosis of patients receiving long-term home oxygen therapy. The Respiratory Failure Research Group in Japan.
Am J Respir Crit Care Med, 152 (1995), pp. 972-976
[61.]
K.A. Franklin, T. Gustafson, J. Ranstam, K. Strom.
Survival and future need of long-term oxygen therapy for chronic obstructive pulmonary disease–gender differences.
Respir Med, 101 (2007), pp. 1506-1511
[62.]
M.C. Machado, J.A. Krishnan, S.A. Buist, A.L. Bilderback, G.P. Fazolo, M.G. Santarosa, et al.
Sex differences in survival of oxygen-dependent patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 174 (2006), pp. 524-529
[63.]
B.R. Celli, P.M. Calverley, S.I. Rennard, E.F. Wouters, A. Agusti, N. Anthonisen, et al.
Proposal for a multidimensional staging system for chronic obstructive pulmonary disease.
Respir Med, 99 (2005), pp. 1546-1554
Copyright © 2010. Sociedad Española de Neumología y Cirugía Torácica
