Barbara Bush was like a growing number of women.
During her final years, the former first lady reportedly had been coping with chronic obstructive pulmonary disease (COPD), along with congestive heart failure.
COPD is a progressive lung disease that includes chronic bronchitis and emphysema.
It’s the third leading cause of death in the United States, as well as a major cause of disability.
It was once known as a “man’s disease.”
However, over the past 50 years, the prevalence of COPD among women in the United States has sharply increased.
Now, COPD afflicts and kills more women than men.
“Things like breast cancer get a lot of attention, but we have many more women die of COPD every year,” Dr. MeiLan Han, MS, an associate professor of medicine in the Division of Pulmonary and Critical Care Medicine at the University of Michigan and a volunteer spokesperson for the American Lung Association, told Healthline.
“We have an increasing number of women with COPD. We now have more women every year who are hospitalized with COPD and women also seem to experience more of the flare-ups associated with COPD, which are these periodic events where you get increased cough and shortness of breath,” she said.
More than 7 million women in the United States are living with a diagnosis of COPD — and many more may have the condition without realizing it.
COPD and smoking
Like many people with COPD, Mrs. Bush, who died last week at the age of 92, had a history of smoking.
According to the American Lung Association, approximately 85–90 percent of COPD cases are linked to cigarette smoke exposure.
While more research is needed to learn why COPD rates have increased in women, shifting smoking patterns have likely played a part.
In the 19th and early 20th centuries in the United States, smoking was largely limited to men and seriously frowned upon in women.
In the 1920s, American tobacco companies began to market their products more aggressively to women. A growing number of women started to smoke.
By 1955, roughly a quarter of women smoked cigarettes, compared to more than half of men.
By 1995, the gap had narrowed after smoking rates declined drastically in men but not in women.
While rates of smoking remain slightly higher in men than women, cigarette smoke may have a greater average impact on women’s health.
“There is some evidence that suggests women may actually be more susceptible to the effects of tobacco smoke,” Han explained.
“For each cigarette smoked, the amount of function loss seems to be greater [for women]. One theory is that it’s because the lungs of women are smaller. If you can imagine, one cigarette is a larger effective dose in women versus men,” she continued.
“But there may be a whole host of other biologic and genetic factors that also drive how a woman’s body reacts to and metabolizes cigarette smoke differently,” she added.
Exposure to secondhand cigarette smoke, outdoor air pollution, and toxic fumes at home or work can also increase your risk of developing COPD and other types of lung disease.
Getting a diagnosis can be challenging
Women may also face gender barriers in getting a COPD diagnosis and treatment.
A recent review of the research literature found that underdiagnosis of COPD might be more common in women than men.
The authors also concluded that women are less likely to receive spirometry, a lung function test that can help doctors diagnose COPD.
“They really cannot tell you [if you have COPD] until they’ve done the appropriate testing, which is a breathing test called spirometry,” Han told Healthline.
“It’s a fairly easy test to be done. It’s painless. But it really needs to be done in order to document what’s going on with the lungs,” she said.
To help improve rates of diagnosis of COPD, Han suggested that it’s important to educate both physicians and the general public.
“People tend to think a little shortness of breath when you get older is normal, and that shouldn’t be the assumption,” she said.
“Then when patients go in to talk to their physicians, their physicians often don’t order appropriate testing. So I think the patient needs to be armed with some knowledge,” she continued. “I think patients need to know that this test exists and to ask for it.”
More research needed
In addition to improving rates of diagnosis of COPD, more work is needed to evaluate and refine available treatments for women.
“Women, for instance, respond differently to different smoking cessation treatments,” Han said, “and we’re exploring more and more whether women may actually respond differently to some COPD medications.”
Research into such topics is limited by the available funding.
In 2018, COPD research has received $79 million in federal funding from the National Institutes of Health (NIH).
In comparison, breast cancer research has received $555 million in funding, despite the fact that breast cancer is associated with a lower disease burden than COPD.
“COPD is a significant outlier in terms of disabilities and death versus how much funding we get,” Han said.
“I think the good news is that women can be incredibly powerful advocates for themselves and for their families,” she continued, “and this is certainly one of those issues that deserves more attention.”
If you’re experiencing shortness of breath or other symptoms of COPD, consider making an appointment with your doctor and asking them about spirometry testing.
To lower your risk of developing COPD, it’s important to take steps to avoid cigarette smoke and other airborne toxins.