COPD with female inequality

2023-11-10 12:24:16

COPD with female inequality

This is indicated by a methodological review of the studies IBERPOC of 1997, EPISCAN from 2007 and EPISCAN II from 2017, of which 14,204 individuals (men and women) were selected, but now analyzed with a sociodemographic profile adapted to the GOLD strategy.

In this sense, the new scrutiny was assessed taking into account the lower limit of normality (LIN) of spirometry in patients diagnosed with chronic obstructive pulmonary disease (COPD) and based on the fixed FEV1/FVC ratio of less than 0.7.

The prevalence of COPD in Spain, before the methodological review, was 9.1% in men and women aged 40 to 69 years (IBERPOC); and 10.2% among people between 40 and 80 years old in EPISCAN (15.1% in men by 5.7% in women).

The EPISCAN II study had reflected that the prevalence in people over 40 years of age was 11.8% (14.6% in men and 9.4% in women).

As for the infradiagnostic of COPD, continues at very high numbers… practically at stable values ​​in the three baseline studies: 77,6 % (IBERPOC), 78,4 % (EPISCAN) and 78,2 % (EPISCAN II).

Before the methodological review of these values, underdiagnosis in Spain stood at 78.2%, 73% and 74.7% (men 70.4% and women 80.6%), respectively.

Regarding underdiagnosis by age and gender, in the methodological review it is observed that it is greater in young adults of the total population studied; and, in general, it is more pronounced in women than in men.

The results of the studyCOPD trends in Spain: changes between cross-sectional surveys carried out in 1997, 2007 and 2017“, led by Dr. Elena García Castillo, have been published in March 2023 in the journal Archivos de Bronconeumología.

45% of the patients analyzed in this methodological review were diagnosed in moderate phases and 5% in severe phases. The diagnosis of his COPD, therefore, was late. Very, very advanced COPD cases, which are admitted and re-admitted to hospital centers.

COPD, with a high prevalence worldwide, is a major health problem in both its individual and population aspects, largely due to its high socioeconomic impact,” highlights the pulmonologist at the La Princesa University Hospital in Madrid.

But the overwhelming data do not stop there, since COPD in Spain has gone from being the fourth cause of mortality in 1990, after ischemic heart disease, cerebral vascular diseases and lung cancer, to appearing in the third position in the ranking in 2017.

Chronic obstructive pulmonary disease causes the death of about 29,000 people each year (17,333 men and 11,433 women).

“And not only do patients die more from chronic obstructive pulmonary disease, but we know that COPD robs them of years and quality of life,” emphasizes the pulmonologist.

It should be noted, as symbolic data from the EPISCAN II study, that girls outnumber boys when it comes to smoking (9% vs. 8%); and in the age range of 10 to 15 years they surpass them by two points (4.5% by 2.5%).

Furthermore, the onset of smoking in Spain has been on average 13.9 years, in the middle of adolescence for girls and boys, a fundamental period of psychophysiological development.

Dr. Elena García Castillo, pulmonologist from La Princesa

Keys to Chronic Obstructive Pulmonary Disease

COPD is essentially characterized by the progressive deterioration of the lungs (bronchi, bronchioles and alveoli) and is clinically manifested by choking, dyspnea or difficulty breathing, often accompanied by cough, with or without expectoration.

The chronic obstructive pulmonary disease is fundamentally linked to smoking habit. Smoke contains around 2,000 chemicals, of which more than 600 are toxic… and 70 are carcinogenicsuch as tar, ammonia, benzene or arsenic.

As triggers for COPD, we must add other risk factors: environmental ones, such as air pollution or biomass combustion, exposure to chemicals in the workplace, and genetic causes, such as alpha-1 antitrypsin deficiency.

Also, abnormal lung development linked to prematurity of the baby and respiratory infections in childhood, such as respiratory syndrome. respiratory syncytial virus.

In the case of women, numerous studies have evaluated the existence of a greater susceptibility to the harmful effects of tobacco, a situation that would be determined by three factors: anatomical, genetic and hormonal.

Anatomical. Their airways are smaller.

Genetics. Women develop the pathology more severely, as do people with a history of smoking mothers, African-American women or those who have suffered respiratory diseases in childhood.

Hormonal. Estrogens in women activate the cytochrome P450 enzyme, which will metabolize different components of cigarettes, giving rise to different carcinogenic and toxic substances.

Clinically, women, although they expectorate and cough less than men, have a greater degree of dyspnea for the same airflow obstruction.

At the same time, it is worth highlighting that the 50% of the Spanish population is sedentary and does not do any recommended sports or daily physical exercise.

An epidemiological review of Spanish COPD

The 1997 IBERPOC study was carried out under LCFA (former ERS) criteria based on data provided by seven Spanish cities from a total spirometric sample of 4,035 patients and ages between 40 and 69 years.

The definition of COPD was predicted by the post-bronchodilator ratio FEV1/FVC <88% in men and <89% in women.

In EPISCAN 2007, there were ten cities studied and a sample of people (3,802) aged between 40-80 years. The post-bronchodilator ratio was FEV1/FVC<0.7.

EPISCAN II was carried out in nineteen cities and with 9,433 people over 40 years of age. The criteria were adjusted to the indications of SEPAR in 2013 and the post-bronchodilator ratio was performed with FEV1/FVC <0.7 and FEV1/FVC

In the methodological review of these three studies, whose objective has focused on evaluating changes in the prevalence of COPD in two decades.

Changes were introduced, the most relevant: GOLD strategy, people between 40 and 69 years of age, with valid spirometryand fixed FEV1/FVC ratio less than 0.7 or under the criterion of the lower limit of normality (LIN). The analysis focused on 14,204 individuals, men and women.

“It is very striking,” says Dr. García Castillo, “that the prevalence now obtained in IBERPOC is 21.6%; while in 2017, in EPISCAN II, it stood at 8.8%, which represents a 59.2% decrease in prevalence.”

“On the other hand, it increases by 1.1%, going from 7.7% to 8.8% from 2007 (EPISCAN) to 2017. It is not a relevant difference, but it does reinforce a trend of data sustained over time,” he explains. .

“If this analysis is carried out using the lower limit of normality (LIN) criterion, we see that these prevalence figures are lower, but we still obtain the same trend,” he says.

“There is a decrease in prevalence of 67.3% (15.6% to 5.1%) between 1997-2017 and a slight increase of 0.6% (4.5% and 5.1%) between 2007 and 2017”, he details.

“Both in the three historical studies on COPD in Spain and in our methodological review of them (prepared in 2002 and published in 2023) it is clear, as a matter of utmost importance, that a large number of the people included suffered from some respiratory symptom,” he points out.

“At least a third of them suffered wheezing (whistling when air moves through damaged airways), but 60% of the subjects register symptoms, such as cough, expectoration and dyspnea -shortness of breath- and wheezing itself,” he relates.

In addition, the study interpreted the results taking into account the previous respiratory diseases of these people: asma, COPDchronic bronchitis and emphysema.

Conclusions of the methodological review of the studies on chronic obstructive pulmonary disease IBERPOC, EPISCAN and EPISCAN II:

The prevalence of COPD in Spain, between 1997 and 2017 in the studied subjects aged 40 to 69, has been reduced by 59.2%. But they have remained very stable from 2007 to 2017.

There are differences in prevalence at extreme ages depending on the use of the LIN spirometric criterion or the fixed FEV1/FVC coefficient.

The underdiagnosis of the disease in the last two decades has been increasing with a clear upward trend in women, a very worrying fact.

The percentage of active smokers among men has decreased in recent decades, but among female smokers it has increased considerably.

Dr. Elena García Castillo, pulmonologist at the La Princesa University Hospital and coordinator of the NeumoMadrid EPOC Group

This videoblog has been prepared based on the intervention of Dr. García Castillo at the debate table “COPD is getting younger and increasingly has a woman’s name” from the scientific program “Visionaries, Innovation and Future in Respiratory Diseases”; a professional meeting that took place on October 6, 2023 in the assembly hall of the La Princesa University Hospital in Madrid.