Women’s lungs are smaller men’s, making them more vulnerable to pollutants, damage and illnesses such as chronic obstructive pulmonary disease (COPD). However, cases of COPD in women are typically overlooked or misdiagnosed.

Why?

“There is some concern that since COPD is considered ‘an old man’s disease’ that women are not getting diagnosed properly,” said MeiLan Han, MD, MS, a professor of pulmonary medicine at the University of Michigan and a spokesperson for the American Lung Association.

COPD is also frequently misdiagnosed as asthma in women. Dawn DeMeo, MD, MPH, an assistant professor at Harvard Medical School in Boston, suggests that clinicians take a more liberal approach to testing  how well their patients’ lungs are working spirometry, a diagnostic tool that “in general tends to be underutilized,” said DeMeo.

Despite the lateness of a diagnosis, women still outpace men when it comes to COPD. One possible reason is the uptick of smoking by women in the 1960s and 70s.

“For every cigarette smoked, women seem to be more susceptible to the lung-related damage that leads to COPD. And we don’t fully understand the mechanism of that susceptibility. It is an area of active research,” DeMeo said. “We know that starting from the time of lung development that estrogens and testosterones have different impacts on lung growth and development, so even from the earliest times of lung development we know that the lung is very susceptible to sex hormones. More research needs to be done to really understand the full impact of hormone biology and COPD.”

Until then, it is important that women—and all COPD sufferers—learn as much as they can about their condition and how it can be treated.