Underdiagnosis of chronic obstructive pulmonary disease in women: quantification of the problem, determinants and proposed actions

Abstract

Introduction: The distribution of chronic obstructive pulmonary disease (COPD) in women, and its underdiagnosis and determinants in the general population, have not been well described. The EPI-SCAN study is an epidemiologic, observational study conducted at 11 Spanish centers on the general population aged 40 to 80.

Patients and method: This paper describes the rates and extrapolates the population burden from the 3,802 participants of the EPI-SCAN study.

Results: With 2,005 female and 1,797 male participants, there was a lower prevalence of COPD in women (5.7%; 95%CI, 4.7-6.7) than in men (15.1%; 95%CI, 13.5-16.8; P<.05). Among the 386 participants with COPD, 114 (29.5%) were women, who were younger, currently smoked less and had lower tobacco smoke exposure, while reporting a lower level of education (P<.05). As for the respiratory symptoms, there were no differences between sexes for cough, dyspnea or wheezing, but the women with COPD reported sputum less frequently (P<.05). There were no differences in the spirometric severity of COPD between women and men. Overall, 73% of the patients with a spirometric COPD criteria were underdiagnosed, and this percentage is unevenly distributed by sex, being 1.27 times more frequent in women (86.0%) than in men (67.6%) (P<.05). By extrapolating the rates of prevalence and underdiagnosis of COPD to the general population, we estimate that there are 628,102 Spanish women between the ages of 40 and 80 with COPD, 540,168 of whom still have not been diagnosed.

Conclusions: There is a greater underdiagnosis of COPD in women than in men in Spain.