Comments on "Chronic obstructive pulmonary disease: Does gender really matter?".

Sir,

I read with interest the article entitled “Chronic obstructive pulmonary disease—Does gender really matter?” published in the October 2011 issue of Lung India.[1] Let me congratulate the authors for such an elaborate and painstakingly prepared article. The older concept of chronic bronchitis, emphysema, and asthma as obstructive airway diseases still lingers in my mind. Being an old-fashioned physician, I am not yet fully convinced with the gender based concept of chronic obstructive pulmonary disease (COPD) given by authors because of many reasons. I want to bring following observations to your notice:

Highly significant number of males (62%) had emphysema as compared to females in this study. Emphysema is a disease characterized by breathlessness and less productive cough. In past, emphysema patients were referred to as “pink puffers.” Weight loss is the main feature of this group but weight loss was more common in females of the present study.

Anemia—more number of females had dirty chest which is, as you have describe aptly, a feature of chronic bronchitis. Chronic bronchitis is usually associated with polycythemia and CO2 retention. In this study, more women were anemic which does not go well with dirty lungs in chest X-ray pictures. Can you explain?

Type of lung cancers would have been additional information, as the underlying causes for COPD in males and females were different.

What is the rationale of evaluating effects of gender on COPD? Is it going to drastically change the concept of COPD affecting treatment outcomesor prevent any major catastrophe related to disease?

I think that the older definition of disease is not just words on a page, it describes the syndrome precisely. If description of “newer entity” that has been originated from the “older one” deviates drastically away from the later, we are probably confusing the issue.

Authors aptly concluded that there is a “gap” in understanding of COPD. These disparities are due to, as per my understanding, inaccurate basic definition of this group of diseases. Present popular guidelines need to consider more elaborate multi-dimensional definition of the disease.