COPD and female inequality
A methodological review of the studies revealed this IBERPOC 1997, EPISCAN Since 2007 and EPISCAN II Starting in 2017, 14,204 of these individuals (male and female) were selected but now analyzed using sociodemographic characteristics suitable for the GOLD strategy.
In this sense, the new review assessment considers the lower limit of normal (LIN) for spirometry in patients diagnosed with chronic obstructive pulmonary disease (COPD) and is based on a fixed FEV1/FVC ratio of less than 0.7.
Before the methodological review, the prevalence of COPD in Spanish men and women aged 40 to 69 years was 9.1% (IBERPOC); in EPISCAN it was 10.2% in those aged 40 to 80 years (15.1% in men and 5.7 in women %).
The EPISCAN II study showed that the prevalence in people over 40 years old was 11.8% (14.6% in men and 9.4% in women).
As for Underdiagnosis The incidence of COPD continues to remain at very high levels…and has actually plateaued in three baseline studies: 77.6% (IBERPOC), 78.4% (EPISCAN) and 78.2% (EPISCAN II).
Before the methodological review of these values, the rates of underdiagnosis in Spain were 78.2%, 73% and 74.7% respectively (70.4% for men and 80.6% for women).
Research resultTrends in chronic obstructive pulmonary disease in Spain: changes between cross-sectional surveys conducted in 1997, 2007 and 2017The study, led by Dr. Elena García Castillo, was published in March 2023 in the journal Archivos de Bronconeumología.
Of the patients analyzed in this methodological review, 45% were diagnosed with the moderate stage and 5% with the severe stage. As a result, his chronic obstructive pulmonary disease (COPD) diagnosis was late. Very, very advanced cases of COPD that are admitted to hospital centers and readmitted.
COPD has a high incidence worldwide and is a major health problem, both in terms of individuals and in the population, mainly due to its large socioeconomic impact,” says the Department of Pulmonary Medicine at the Princess Royal University Hospital in Madrid. the doctor emphasized.
But the overwhelming data does not stop there. COPD in Spain has risen from the fourth leading cause of death in 1990, after ischemic heart disease, cerebrovascular disease and lung cancer, to the fourth in 2017. Ranked third in 2017.
Causes of chronic obstructive pulmonary disease Approximately 29,000 people die each year (17,333 men and 11,433 women).
“Not only does COPD kill more patients, but we know that COPD robs them of years and quality of life,” the pulmonologist stressed.
It should be noted that, as an indicative figure for the EPISCAN II study, girls are more likely to smoke than boys (9% vs. 8%); in the 10 to 15 age range they exceed them by two percentage points (4.5% vs. 2.5%).
Furthermore, the average age of smoking in Spain is 13.9 years, which for both boys and girls is mid-adolescence, a fundamental period of psychophysiological development.
The Key to Chronic Obstructive Pulmonary Disease
The essential characteristic of COPD is the progressive deterioration of the lungs (bronchi, bronchioles, and alveoli), with clinical manifestations of suffocation, dyspnea, or dyspnea, often accompanied by cough, with or without sputum production.
this chronic obstructive pulmonary disease Fundamentally with Smoking habit.Smoke contains approximately 2,000 chemicals, more than 600 of which are toxic…and 70 types of carcinogenssuch as tar, ammonia, benzene or arsenic.
We must add other risk factors as contributors to COPD: environmental factors, such as air pollution or biomass burning, exposure to chemicals in the workplace, and genetic factors, such as alpha-1 antitrypsin deficiency.
In addition, abnormal lung development is associated with premature birth in infants and respiratory infections (such as respiratory syndrome) in childhood. respiratory syncytial virus.
In the case of women, numerous studies have evaluated whether women are more susceptible to the harmful effects of tobacco, which is determined by three factors: anatomy, genetics, and hormones.
anatomy. Their airways are smaller.
genetics. The disease is more severe in women, those with a history of smoking mothers, African-American women, or those who had respiratory problems in childhood.
hormones. Estrogen in women activates cytochrome P450 enzymes, which metabolize different components in cigarettes to produce different carcinogenic and toxic substances.
Clinically, although women expect less phlegm and cough than men, their dyspnea is more severe under the same airflow obstruction.
At the same time, it is worth emphasizing that 50% of the Spanish population is sedentary and not engaging in any recommended exercise or daily physical activity.
Epidemiological review of chronic obstructive pulmonary disease in Spain
The 1997 IBERPOC study was conducted according to LCFA (formerly ERS) standards and was based on data provided by seven Spanish cities from total spirometry samples of 4,035 patients aged 40 to 69 years.
COPD was defined by the postbronchodilator FEV1/FVC ratio (<88% in men and <89% in women).
EPISCAN 2007 studied 10 cities and a sample of 3,802 people aged 40 to 80 years. The post-bronchodilator ratio is FEV1/FVC<0.7.
EPISCAN II was conducted in 19 cities and involved 9,433 people aged 40 and over. The criteria were adjusted according to the indications of SEPAR in 2013. The post-bronchodilator ratio is based on FEV1/FVC<0.7 and FEV1/FVC
In a methodological review of these three studies, the aim focused on assessing changes in COPD prevalence over two decades.
The most relevant changes are introduced: Gold strategy, people between 40 and 69 years old, Effective spirometryand fix the FEV1/FVC ratio to a standard less than 0.7 or lower than the lower limit of normal (LIN). The analysis focused on 14,204 men and women.
Dr. García Castillo said: “It is alarming that the current prevalence in IBERPOC is 21.6%; in 2017, in EPISCAN II it was 8.8%, meaning The prevalence dropped by 59.2%.”
“On the other hand, from 2007 (EPISCAN) to 2017, it increased by 1.1%, from 7.7% to 8.8%. This is not a relevant difference, but it does reinforce the continuing trend in the data over time,” he explained. .
“If we do the analysis using the lower limit of normal (LIN) criteria, we see these prevalence numbers are lower, but we still get the same trends,” he said.
“Between 1997 and 2017, the prevalence decreased by 67.3% (15.6% to 5.1%), and between 2007 and 2017 it increased slightly by 0.6% (4.5% to 5.1%),” he details.
“Three historical studies on COPD in Spain, as well as our methodological review of these studies (prepared in 2002 and published in 2023), reveal a very important fact, which is that a large proportion of them suffer from some kind of Respiratory symptoms,” he noted.
“At least one-third of people suffer from respite (A pitching sensation occurs when air flows through damaged airways), but 60 percent of subjects experienced symptoms such as coughing, sputum production, dyspnea (shortness of breath), and wheezing,” he said.
Additionally, the study took these people’s previous respiratory illnesses into account when interpreting the results: asthma, chronic obstructive pulmonary diseasechronic bronchitis and emphysema.
Conclusions of the methodological review of the IBERPOC, EPISCAN and EPISCAN II studies in chronic obstructive pulmonary disease:
Between 1997 and 2017, the prevalence of COPD in Spanish study subjects aged 40 to 69 fell by 59.2%. But from 2007 to 2017, they have remained very stable.
There are differences in the prevalence of extreme age according to the use of LIN vital capacity criteria or fixed FEV1/FVC coefficients.
The underdiagnosis of this disease has been increasing over the past two decades, with a clear rise among women, which is a very worrying fact.
The proportion of male active smokers has declined in recent decades, but the proportion of female smokers has increased significantly.
Dr. Elena García Castillo, pulmonologist at the University Hospital Princessa and coordinator of the NeumoMadrid EPOC Group
This vlog was prepared based on Dr. Garcia Castillo’s remarks on the debate stage”COPD affects younger people and is increasingly named after women” from Science Project “Visionaries, innovations and the future in respiratory disease”; Professional meeting held on 6 October 2023 in the auditorium of the University Hospital of La Princesa in Madrid.