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Published on: October 22, 2020
Sexually dimorphic response to tobacco exposure in COPD: a systematic review and meta-analysis
Ryan Chow1, Michelle Pham2, Matthew Cope1
1University of Ottawa, Faculty of Medicine, Ottawa, Canada.
Background:
Chronic obstructive pulmonary disease (COPD) is a heterogeneous, progressive pulmonary disorder with persistent respiratory symptoms resulting from abnormalities in the airways and/or alveoli and was prevalent globally in 10.3% of people aged 30-79 years in 2019. The prevalence of COPD has increased rapidly in women in the past decade. This may be due to increased tobacco use, but may also involve sex-specific factors.
Purpose:
To evaluate the prevalence of COPD in the context of sex and tobacco exposure.
Data Sources And Searches:
Comprehensive searches of MEDLINE (OVID), EMBASE and CENTRAL were conducted for articles published from inception to July 22, 2022.
Study Selection:
We independently evaluated titles, abstracts and full-text articles in a duplicated two-staged process. Studies were included if they reported the prevalence of COPD as a primary outcome in the context of sex and tobacco exposure.
Data Synthesis And Analysis:
Pooled analysis was conducted with Review Manager 5, and heterogeneity was assessed with the I2 statistic. For 163, 450 individuals the prevalence of COPD was 3.5-20.7% in males and 6.3-18.5% in females, and we observed a non-statistically significant difference of 1.53% [95% CI: -5.83, 8.89] (p = 0.68) in females compared to males with tobacco exposure (Tau2 = 54.02; Chi2 = 53.15; df = 4 (P < 0.00001); I2 = 92%). Females with COPD had earlier mortality, greater co-morbidities involving cardiovascular disease and others, and decreased FEV1% predicted, as compared to males with COPD. Estrogen and androgens may protect against COPD, but smoking-induced hypogonadism may diminish these effects. Menopause could also be a contributor to worse COPD outcomes.
Limitations:
Included articles are limited by the quality of data on tobacco smoke exposure, primarily reported as a binary risk factor, with lack of availability on duration and intensity of exposure.
Conclusion:
There was earlier mortality and reduced FEV1 in females with COPD, as compared to males with COPD. Thus, sex-specific considerations are important in understanding the pathophysiology of COPD and should be a focus of further research.
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