COPD Incidence on the Rise Among Women with Asthma

More than 4 in 10 women with asthma may develop chronic obstructive pulmonary disorder, but many risk factors are modifiable.

Women with asthma are experiencing increased rates of worsening disease, with more than 4 in 10 women developing chronic obstructive pulmonary disorder (COPD), according to a new study published in the Annals of the American Thoracic Society.

In the study, the researchers followed 4051 women with asthma for an average of 14 years after diagnosis. They examined the potential risk factors for developing asthma and COPD overlap syndrome (ACOS), including increased exacerbations and hospitalizations, and lower quality of life.

Of the women included, 42% developed COPD over the course of the study period, according to the researchers. After examining the risk factors involved, the researchers noted that individual risk factors appeared to play a more significant role in the development of ACOS than exposure to air pollutants.

“Previous studies have found an alarming rise in ACOS in women in recent years and that the mortality rate from ACOS was higher in women than men,” Teresa To, PhD, a professor in the Graduate School of Public Health at the University of Toronto, said in a statement. “We urgently need to identify and quantify risk factors associated with ACOS in women to improve their health and save lives.”

Not surprisingly, women who had smoked more than the equivalent of a pack of cigarettes per day for 5 years were much more likely to develop ACOS than those who smoked fewer cigarettes or never smoked. However, 38% of the women who developed ACOS had never smoked, indicating that smoking is not the only risk factor involved, the researchers noted.

They identified several other potential risk factors: obesity, rural residence, lower education levels, and unemployment. The researchers indicated that, due to low socioeconomic status, many of the women who exhibited these risk factors may have lacked optimal access to care and demonstrated poor adherence to medications—leading to increased risk of developing ACOS.

According to the researchers, they lacked the data to investigate the association directly. However, they noted that it was encouraging that most of the risk factors identified were modifiable.

“The adverse impact of smoking and obesity on health may be even worse in those who are already living with asthma or COPD,” Dr To said in the press release. “Identifying modifiable risk factors in the progression from asthma to COPD is an essential first step in developing prevention strategies that lead to a healthy, active lifestyle.”

Overall, prevention strategies targeting modifiable risk factors, as well as health promotion and education, has the potential to reduce the rising ACOS incidence among women, the researchers concluded.


To T, Zhu J, Gray N, et al. Asthma and COPD overlap in women: incidence and risk factors. Annals of the American Thoracic Society. 2018.

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