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Sex differences in COPD in relation to smoking exposure: a population-based cohort study
Yunus Çolak1,2, Børge G Nordestgaard2,3, Peter Lange1,2,4
1Department of Respiratory Medicine and the Copenhagen General Population Study, Copenhagen University Hospital, Copenhagen, Denmark.
Thorax
|April 4, 2025
Summary
Females are more susceptible to smoking’s harmful effects on chronic obstructive pulmonary disease (COPD). This study found higher risks of COPD development and worse prognosis in female smokers compared to males, highlighting sex-based differences in smoking-related respiratory disease.
Area of Science:
- Pulmonary Medicine
- Environmental Health
- Epidemiology
Background:
- Controversy exists regarding sex-based differences in the impact of smoking on chronic obstructive pulmonary disease (COPD) development and prognosis.
- This study investigated whether females exhibit greater susceptibility to the detrimental effects of smoking concerning COPD compared to males.
Purpose of the Study:
- To determine if females are more vulnerable than males to smoking-induced COPD.
- To analyze sex-specific associations between smoking quantity and COPD outcomes.
Main Methods:
- Utilized data from 47,231 males and 57,806 females in the Copenhagen General Population Study.
- Employed logistic regression for cross-sectional associations (airway obstruction, chronic bronchitis, dyspnea) and Cox regression for longitudinal outcomes (exacerbation, mortality), adjusting for confounders.
Main Results:
- Increased risks for airway obstruction, chronic bronchitis, and dyspnea with higher smoking amounts were greater in females than males.
- Over 15 years, females showed a greater increase in risk for exacerbation, respiratory mortality, and all-cause mortality with increased smoking compared to males.
- Hazard ratios for exacerbation and mortality demonstrated a more pronounced increase with smoking pack-years in females across all measured outcomes.
Conclusions:
- Females appear to be more susceptible to the adverse effects of smoking on both the development and prognosis of COPD.
- Findings suggest significant sex-based disparities in COPD risk and progression related to smoking exposure.
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