Chronic obstructive pulmonary disease (COPD) is a preventable and treatable lung disease characterised by airflow limitation that is not fully reversible. While COPD is often considered a disease of older male smokers, it is slightly more prevalent in women in Australia, affecting around 2.6% of females and 2.4% of males.
What causes COPD?
Most cases of COPD are smoking-related, and women appear to be more susceptible to the harmful effects of tobacco smoke than men, with women developing more severe disease for an equivalent smoking history. Other exposures (e.g. biomass fuels, occupational dust, second-hand smoke) can also cause or contribute to the development of COPD.
Symptoms of COPD
The primary symptoms of COPD include a persistent cough, breathlessness, sputum production, or a history of recurrent lower respiratory tract infections, and COPD should be considered in any woman presenting with these symptoms, particularly if they have a smoking history. For the same disease severity, women present with increased anxiety, fatigue, more frequent exacerbations and greater variation in symptomatology than men.
Diagnosing COPD
Diagnosis of COPD in women primarily relies upon spirometry. This involves measuring forced expiratory volume in 1 second (FEV₁) and forced vital capacity (FVC). COPD is confirmed when the post-bronchodilator FEV₁/FVC ratio is <0.7. It is also important to screen for comorbidities, particularly those which disproportionately affect women, for example, osteoporosis, cardiovascular disease, anxiety and depression.
COPD management
Management of COPD in women requires a holistic and personalised approach. COPD is generally considered a progressive disease, and evidence suggests a steeper decline in lung function in women compared to men; however, deterioration can be slowed or stabilised with effective management. Smoking cessation is the most effective intervention to slow disease progression and should be a primary focus for any woman with a diagnosis of COPD. It is important to note that women may have a higher nicotine dependence and more severe withdrawal symptoms than men and may require the use of both behavioural and pharmacological support to stop smoking. Medications such as varenicline, bupropion, or nicotine replacement therapy can be safely used in most women.
Primary pharmacological management of COPD typically involves a daily long-acting bronchodilator. Correct inhaler technique and adherence are important issues to address in primary care following a diagnosis. Women should also be counselled on recognising COPD exacerbations, and an exacerbation management plan should be formulated, including instructions on the use of oral corticosteroids and antibiotics when required.
Women should be encouraged to engage in pulmonary rehabilitation, which can improve exercise tolerance, reduce breathlessness, and enhance quality of life, even in mild COPD. It is important to recognise that women may face specific barriers to engagement, for example, caring responsibilities or social stigma. Women with COPD are recommended to receive annual influenza and pneumococcal vaccinations to reduce exacerbation frequency and hospitalisations, which can be arranged through primary care. Aspects such as bone health, cardiovascular risk and psychological health should be addressed as part of a holistic management plan. Women with severe disease, diagnostic uncertainty, frequent exacerbations or complications should be referred to secondary care for evaluation.
COPD in women remains an under-recognised but highly impactful disease. With timely diagnosis, early intervention and patient-centred management, GPs are uniquely placed to significantly improve the quality of life and long-term outcomes of women with COPD.
- Dr Samantha Miller, MBChB
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References
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- National Institute for Clinical Excellence (NICE)(2019). Chronic obstructive pulmonary disease in over 16s: diagnosis and management. https://www.nice.org.uk/guidance/ng115
- BMJ Best Practice (2025). Chronic Obstructive Pulmonary Disease (COPD). https://bestpractice.bmj.com/topics/en-gb/7
- The Royal Australian College of General Practitioners (2010). COPD Diagnosis, management and the role of the GP. https://www.racgp.org.au/afp/2010/march/copd-diagnosis-management-and-the-role-of-the-gp
- Lung Foundation Australia (2024). COPD-X Handbook. https://lungfoundation.com.au/wp-content/uploads/2025/06/COPD-X_Handbook_Version1-1.pdf
- Department of Health, State Government of Victoria, Australia. Better Health Channel: Lung Conditions – Chronic Obstructive Pulmonary Disease (COPD). https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/lung-conditions-chronic-obstructive-pulmonary-disease-copd
- Australian Institute of Health and Welfare (AIHW) (2023). COPD statistics and trends. https://www.aihw.gov.au/reports/chronic-respiratory-conditions/copd
- Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2024). Global strategy for the diagnosis, management and prevention of COPD. https://goldcopd.org/2024-gold-report/
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