Call to action: improving primary care for women with COPD
Introduction
- Chronic obstructive pulmonary disease (COPD) is a significant and growing health burden in women worldwide; there is often a disregard for COPD as a women’s issue. Primary care physicians play a central role in overseeing the multidisciplinary care of women with COPD. In this review, the authors summarise key literature and provide their thoughts on how to improve the management of COPD in women worldwide.
- In this review, authors summarise key literature and provide their thoughts on how to improve the awareness, prevention and gender-focused management of COPD in women worldwide.
The increasing burden of COPD in women
- Data from many countries indicate a similar prevalence of COPD in men and women1 which is continuing to rise.2
- An increase in smoking, exposure to biomass fuel smoke and occupational risk factors are likely to have contributed to the increasing prevalence of COPD in women.3
- COPD mortality data is an indicator of disease burden; surveillance data indicates increasing COPD mortality in women worldwide.4,5
Improving diagnosis in women with COPD
- There is a higher rate of under- or misdiagnosis of COPD in women versus men, potentially due to gender bias,6–12 and a lack of symptom awareness among women.13 This may result in a delayed diagnosis in women and a delay to treatment.
- Primary care consultations should include the careful obtainment of patient history, use of symptom-based questionnaires and a thorough physical examination.14–16
- A COPD diagnosis should be considered in any woman who has been exposed to risk factors, presents with key symptoms and/or who obtains a positive result on COPD risk evaluation questionnaire.16
- Physicians should be alert to the early identification and diagnosis of COPD due to an increased exposure to risk factors.3,17Compared with men, women with COPD are generally younger, smoke less and have a lower socioeconomic status.6,18–20
- Physicians should be aware of gender-related differences in COPD presentation to aid early diagnosis, and reduce the potential for misdiagnosis in women with COPD.8
- Full spirometry with bronchodilation should be used to confirm a COPD diagnosis and initiate treatment;8,15 micro-spirometry will identify patients who require further investigation, and exclude those who do not.16
- Author suggestions: primary care physicians should be aware of gender-related differences in COPD and follow proper processes, such as the use of validated questionnaires and micro-spirometry in order to facilitate prompt COPD diagnosis and disease monitoring.
Barriers to accessing healthcare for women with COPD
- Using screening questionnaires could identify women with COPD who dismiss their symptoms and do not seek medical help.16,21,22
- Women may be reluctant to seek medical care due to the social stigma associated with various symptoms of COPD.23
- Poverty is more common in women than in men, particularly in the older population.
- This may impact access to healthcare and time to COPD diagnosis.23,24
- Physicians are less likely to recognise COPD in women versus men, thus women who approach their healthcare provider may not receive suitable intervention.7,11,12
- Author suggestions: Community initiatives and social support programmes would help to increase COPD awareness and reduce stigma associated with the disease, and ensure all women have access to healthcare.
Achieving goals in the treatment of women with COPD
- Careful consideration should be given to any factors that may require modification of treatment in order to reduce COPD burden and prevent or slow disease progression in women with COPD.15,25
- Women may experience greater problems with shortness of breath, a greater number of exacerbations and a faster disease progression than men with COPD, highlighting a greater need for disease management.15,25–27
- Intervention programs aimed at achieving treatment goals in women with COPD can be conducted in primary care.28,29
- Education programs discussing risk avoidance, early recognition of symptoms and the need to seek medical help, physical exercise, diet, and self-management, may empower women to take control of their disease. A multidisciplinary approach would ensure optimal COPD management.15
- Author suggestions: Emphasise gender differences in symptom burden and disease presentation, and the benefits of different intervention programs.
Treating comorbidities in women with COPD
- Comorbidities such as asthma, osteoporosis, anxiety and depression are more common in women versus men and have a detrimental impact on quality of life.12,25
- For similar levels of lung function decline, women may be at a greater risk of lung cancer than men.30
- Primary care physicians should recognise the impact of comorbidities and ensure they are treated quickly and appropriately.15 Medications used to treat comorbidities may offer additional beneficial effects for patients with COPD.
- Prescribing ICS in women should warrant careful consideration due to the increased prevalence of osteoporosis in women with COPD.31,32
- Author suggestions: Particular attention should be paid to unrecognised or untreated comorbidities, especially those that appear more frequently in women than in men. Patients receiving treatment for multiple conditions should be monitored to ensure full compliance to medication and to ensure all drug effects carefully considered.
Patient reviews
- Women with COPD should receive regular reviews to optimise treatment and slow disease progression, at which disease severity, exacerbation risk and disease impact should be assessed. Gender-related differences in COPD should remain considered.
- COPD-specific quality-of-life questionnaires and spirometry should be conducted at each review in order to identify any symptomatic changes or decline in lung function.
- Primary care physicians should use review sessions as an opportunity to reinforce disease education and review pharmacological interventions to ensure adequate disease management.
- Author suggestions: physicians should use patient reviews in order to optimise disease management, using a structured and appropriate assessment to highlight specific issues for women with COPD.
Summary
- Primary care physicians play a pivotal role in the identification and treatment of women with COPD, and should strive to improve the management of patients in their care by increasing awareness and education of COPD in women.
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Developed by EPG Health for Medthority in collaboration with Novartis Pharma AG, with content provided by Novartis Pharma AG. The views presented in the videos are those of the presenters and not necessarily those of the industry sponsor, Novartis Pharma AG. Any data on non- Novartis products are based on publicly available information at the time of content update. Prescribing information may vary depending on local health authority approval in each country. Before prescribing any product, always refer to the SmPC or product information approved in your local country. Inhaled management of COPD: GLRESP/RESP/0386.