title: Reconsidering sex-based stereotypes of COPD.
abstract: Chronic obstructive pulmonary disease (COPD) has historically been considered a disease of older, white, male smokers, as illustrated in  Frank Netter's classic images of the 'pink puffer' and 'blue bloater'. However, women may be more susceptible to COPD than men, and  the disease course may be reflective of that increased susceptibility. From a review of epidemiological data of COPD, we found differences  in the way men and women present with COPD symptoms, a bias in the way COPD symptoms are treated in men and women, and  differences in susceptibility to airway obstruction based on age, sex, and smoking history. These data show that classic stereotypes of  COPD - including male predominance - should be abandoned, and that there are not two but multiple COPD phenotypes, which are  characterised by differences between women and men in susceptibility, symptoms, and disease progression. These differences impact on  physician perception. Although further research into this concept is needed, the differences we found should prompt, in the short term,  changes in the way (and in whom) COPD is evaluated, diagnosed, and treated; in the long term, these differences should prompt research  into the prognosis of COPD based on sex differences.
authors.affiliation: Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University Health Sciences, Medical Center Boulevard, Winston Salem, NC 27157, USA. johar@wfubmc.edu
authors.forename: Jill
authors.initials: J
authors.lastname: Ohar
authors.forename: Leonard
authors.initials: L
authors.lastname: Fromer
authors.forename: James F
authors.initials: JF
authors.lastname: Donohue
mesh_terms: D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation