– ESTEVE TEIJIN – Archivo
MADRID, March 2, 2026 –
The incidence of chronic obstructive pulmonary disease (COPD) is increasing among women, prompting calls for a reevaluation of diagnostic approaches and clinical care with a focus on gender-specific considerations, according to Dr. Sandra Vañes, a pulmonologist and medical director at Linde Medical.
For decades, COPD was largely considered a condition affecting primarily men. However, the gap between the sexes has narrowed significantly. In some Western countries, mortality rates from COPD are now equal to, or even higher in, women than in men. This shift highlights the growing importance of understanding how COPD presents and progresses differently in women.
Data reveal a changing epidemiological landscape: more women are living with COPD, many are experiencing initial symptoms at younger ages, and a substantial number remain undiagnosed. “COPD in women has unique epidemiological, biological, and psychosocial characteristics that we must integrate into diagnosis and management. It’s a COPD with its own nuances. Recognizing these differences doesn’t divide, it improves care,” Dr. Vañes stated.
Scientific evidence supports the existence of these distinctions. Biologically, women have anatomically narrower airways and exhibit differences in inflammatory responses and smoke metabolism. “Women not only have a smaller bronchial caliber, but there are hormonal differences and variations in the expression of certain inflammatory mediators that can influence how the lungs respond to chronic smoke exposure. They also metabolize certain tobacco toxins differently, potentially leading to earlier or more severe damage with the same level of exposure,” Dr. Vañes explained.
The way the disease manifests also differs. “In men, the destruction of deep lung tissue, particularly the small air sacs responsible for oxygen uptake, is more prevalent. Women tend to develop symptoms earlier, often experience greater shortness of breath for the same degree of airway obstruction, produce less sputum, and have a more pronounced bronchial component, along with a higher frequency of exacerbations and overlap with asthma. With equivalent tobacco exposure, women appear to develop greater airway obstruction,” Dr. Vañes said.
Systemic differences are also notable. “Women with COPD are significantly more likely to experience conditions like anxiety and depression, osteoporosis and fracture risk, and malnutrition and sarcopenia, while men are more prone to cardiovascular and metabolic comorbidities,” she noted.
Current clinical guidelines do not specify different treatment approaches based on sex, and bronchodilators and pulmonary rehabilitation demonstrate similar benefits in both men and women. However, some analyses suggest women may respond better to inhaled corticosteroids and experience greater adherence and benefit from home oxygen therapy, even though further evidence is needed.
“It’s not about treating differently based on sex, but about better understanding the differences to personalize care more effectively. We need clinical trials that analyze outcomes stratified by sex,” Dr. Vañes insisted.
UNDERDIAGNOSIS AND LOWER QUALITY OF LIFE
This distribution directly impacts quality of life. Studies show women report poorer health perceptions and greater functional limitations, even with similar lung function. However, survival rates following hospitalization for COPD exacerbations are better in women. A cohort study published in ‘Thorax’ found that the adjusted risk of mortality after COPD hospitalization was approximately 1.45 times higher in men.
This impact on quality of life is linked to delayed diagnosis. Research indicates women with COPD are more frequently underdiagnosed and sometimes initially mislabeled as having asthma or even anxiety disorders. “This diagnostic delay means treatment is initiated later and patients present with a greater symptom burden and reduced quality of life. COPD in women is not only different; it has also been less recognized,” Dr. Vañes warned.
Experts agree that it’s crucial to increase clinical suspicion of COPD in women presenting with persistent breathlessness, even with lower smoking histories; systematically incorporate assessments for anxiety, depression, and bone health into their follow-up care; avoid minimizing symptoms by attributing them to emotional causes; and promote targeted prevention campaigns focused on both smoking cessation and improving indoor air quality.
“Ignoring these differences doesn’t produce us more equitable, it makes us less precise. Integrating a sex and gender perspective into research and clinical practice is the first step toward providing more just, more personalized, and more effective care,” Dr. Vañes concluded.
