BackgroundThe number of female smokers developing chronic obstructive pulmonary disease (COPD) is rapidly increasing, but whether or not there exists a differential susceptibility by gender remains controversial. Methods How smoking behaviour and subsequent lung function reduction differed by gender was examined in a study including 954 subjects with COPD and 955 subjects without COPD. The study focused on two subgroups: subjects with COPD <60 years of age (earlyonset group, n¼316) and subjects with COPD with <20 pack-years of smoking (low exposure group, n¼241). Results In the low exposure group, female subjects with COPD had lower forced expiratory volume in 1 s (FEV 1 ) % predicted (48.7% vs 55.8%, p¼0.001) and more severe disease (50.4% vs 35.6%, p¼0.020, in GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage 3 and 4) than male subjects with COPD. Females also had lower FEV 1 % predicted (50.6% vs 56.0%, p¼0.006) and more severe COPD (41.7% vs 31.1% in GOLD stage 3 and 4, p¼0.050) in the early-onset group. Using multivariate regression, female gender was associated with 5.7% lower FEV 1 % predicted in the low exposure group (p¼0.012) and a similar trend was observed in the early-onset group (p¼0.057). The number of pack-years was not significantly associated with lung function in female subjects with COPD in this study, and the doseeresponse relationship between smoking and lung function differed by gender at lower levels of smoking exposure. Interaction analysis suggested that the effect of smoking on lung function might be different by gender (p¼0.027 in all subjects with COPD). Conclusions Female gender was associated with lung function reduction and more severe disease in subjects with COPD with early onset of disease or low smoking exposure. The findings may suggest a gender difference in susceptibility to the lung-damaging effects of cigarette smoking, but alternative explanations should be considered.For many years chronic obstructive pulmonary disease (COPD) was considered a disease of men, with higher global prevalence in men than in women. Today the number of women with COPD is rapidly increasing, and for the first time the number of deaths from COPD in women have surpassed those in men in the USA. 1 This development has been attributed to changes in the historical differences in smoking behaviour in men and women. Recent research has suggested that women may be more susceptible to the lungdamaging effects of smoking, but the findings are inconsistent. Several studies have indicated an increased female susceptibility to smoking-related decline in lung function, 2e7 whereas other studies have suggested an opposite gender effect.8 Whether or not there exists a differential susceptibility by gender remains controversial, and little is known about the mechanisms and implications of a possible gender difference in COPD.Maleefemale differences are often divided into sex-related (biological) and gender-related (environmental and socio-cultural) differences. 9 In this manuscript, w...

AWT affected mortality with increasing degree of emphysema, whereas CT measure of emphysema was a strong independent mortality predictor.

Background: The Global Initiative for Obstructive Lung Disease (GOLD) has defined chronic obstructive pulmonary disease (COPD) as a post-bronchodilator ratio of forced expiratory volume in 1 second to forced vital capacity (FEV 1 /FVC) of ,0.7. In the first general population based study to apply postbronchodilator values, the prevalence and predictors of GOLD defined COPD were assessed and the implications of b 2 agonist reversibility testing examined. Methods: Based on a random population sample, 2235 subjects (77%) aged 26-82 years performed spirometric tests before and 15 minutes after inhaling 0.3 mg salbutamol. Results: The prevalence of GOLD defined COPD was 7.0% (95% confidence interval (CI) 5.9 to 8.0). This estimate was 27% lower than COPD defined without bronchodilatation. One percent of the population had severe or very severe COPD. Compared with women, men had 3.1 (95% CI 2.1 to 4.8) times higher odds for COPD. Subjects with a smoking history of more than 20 pack years had an odds ratio (OR) of 6.2 (95% CI 3.4 to 11.0) for COPD relative to never-smokers, while subjects older than 75 years had an OR of 18.0 (95% CI 9.2 to 35.0) relative to those below 45 years. Subjects with primary education only had an OR of 2.8 (95% CI 1.4 to 5.3) compared with those with university education. Subjects with body mass index (BMI) ,20 kg/m 2 were more likely than subjects with BMI 25-29.9 kg/m 2 to have COPD (OR 2.4, 95% CI 1.1 to 5.3). The adjusted proportion of COPD attributable to smoking was 68%. Conclusions: These results indicate that community programmes on prevention of COPD should focus on anti-smoking, nutritional aspects, and socioeconomic conditions. The effect of b 2 reversibility testing on prevalence estimates of COPD was substantial.

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