Chronic Obstructive Pulmonary Disease in Women: A Biologically Focused Review with a Systematic Search Strategy

Abstract

Purpose: Evidence suggests that chronic obstructive pulmonary disease (COPD) symptoms and progression may differ between men and women. However, limited information is currently available on the pathophysiological and biological factors that may underlie these sex-related differences. The objective of this review is to systematically evaluate reports of potential sex-related differences, including genetic, pathophysiological, structural, and other biological factors, that may influence COPD development, manifestation, and progression in women.

Patients and methods: A PubMed literature search was conducted from inception until January 2020. Original reports of genetic, hormonal, and physiological differences, and biological influences that could contribute to COPD development, manifestation, and progression in women were included.

Results: Overall, 491 articles were screened; 29 articles met the inclusion criteria. Results from this analysis demonstrated between-sex differences in inflammatory, immune, genetic, structural, and physiological factors in patients with COPD.

Conclusion: Various biological differences are observed between men and women with COPD including differences in inflammatory and metabolic pathways related to obesity and fat distribution, immune cell function and autophagy, extent and distribution of emphysema and airway wall remodeling. An enhanced understanding of these differences has the potential to broaden our understanding of how COPD develops and progresses, thereby providing an opportunity to ultimately improve diagnosis, treatment, and monitoring of COPD in both men and women.

Keywords: COPD; biological; sex; systematic review; women.

Figure 1

Flowchart of the included studies. Notes: ^aArticles reporting adherence, asthma-COPD overlap, clinical characteristics, epidemiology, healthcare costs, hospitalizations, monitoring, risks associated with COPD, quality of life, animal models, and underdiagnoses. Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 2

Sex differences in COPD. Abbreviations: CCR, CC chemokine receptor; CD, cluster of differentiation; CELSR1, cadherin EGF LAG seven-pass G-type receptor 1; COPD, chronic obstructive pulmonary disease; CRP, C-reactive protein; FABP4, fatty acid‒binding protein 4; IL, interleukin; VEGF, vascular endothelial growth factor.