abstract: 'An individual''s experience of COPD is determined by many factors in

  addition to the pathological features of chronic bronchitis and

  emphysema and the symptoms that derive directly from them.

  Multimorbidity is the norm rather than the exception, so most people

  with COPD are living with a range of other medical problems which can

  decrease overall quality of life. COPD is caused by the inhalation of

  noxious particles or gases, in particular tobacco smoke, but also by

  early life disadvantage impairing lung development and by occupations

  where inhaled exposures are common (e.g. industrial, farming and

  cleaning work). Wealthy people are therefore relatively protected from

  developing COPD and people who do develop the condition may have reduced

  resources to cope.

  COPD is also no longer a condition that predominantly affects men. The

  prevalence of COPD among women has equalled that of men since 2008 in

  many high-income countries, due to increased exposure to tobacco, and in

  low-income countries due to biomass fuels. COPD is one of the leading

  causes of death in women in the USA, and death rates attributed to COPD

  in women in some countries are predicted to overtake those of men in the

  next decade. Many factors contribute to this phenomenon, but in addition

  to socioeconomic and occupational factors, there is increasing evidence

  of a higher susceptibility of females to smoking and pollutants. Quality

  of life is also more significantly impaired in women. Although most

  medications (bronchodilators and inhaled corticosteroids) used to treat

  COPD demonstrate similar trends for exacerbation prevention and lung

  function improvement in men and women, this is an understudied area and

  clinical trials frequently have a preponderance of males. A better

  understanding of gender-based predictors of efficacy of all therapeutic

  interventions is crucial for comprehensive patient care. There is an

  urgent need to recognize the increasing burden of COPD in women and to

  facilitate global improvements in disease prevention and management in

  this specific population.

  Many individuals with COPD follow a trajectory of both lung function

  decline and also multimorbidity. Unfavourable lung function trajectories

  throughout life have implications for later development of other chronic

  diseases. An enhanced understanding of the temporal associations

  underlying the development of coexisting diseases is a crucial first

  step in unravelling potential common disease pathways. Lessons can be

  learned from exploring disease trajectories of other NCD as well as

  multimorbidity development. Further research will be essential to

  explain how early life risk factors commonly influence trajectories of

  COPD and other diseases, how different diseases develop in relation to

  each other in a temporal way and how this ultimately leads to different

  multimorbidity patterns in COPD.

  This review integrates new knowledge and ideas pertaining to three broad

  themes (i) the overall burden of disease in COPD, (ii) an unappreciated

  high burden in women and (iii) the contrast of COPD trajectories and

  different multimorbidity patterns with trajectories of other NCD. The

  underlying pathology of COPD is largely irreversible, but many factors

  noted in the review are potentially amenable to intervention. Health and

  social care systems need to ensure that effective treatment is

  accessible to all people with the condition. Preventive strategies and

  treatments that alter the course of disease are crucial, particularly

  for patients with COPD as one of many problems.'
affiliation: 'Zysman, M (Corresponding Author), CHU Bordeaux, Serv Malad Resp, Ave
  Magellan, F-33604 Pessac, France.

  Hopkinson, NS (Corresponding Author), Imperial Coll, Natl Heart \& Lung Inst, Royal
  Brompton Hosp Campus,Fulham Rd, London SW3 6HP, England.

  Vanfleteren, LEGW (Corresponding Author), Univ Gothenburg, Sahlgrenska Univ Hosp,
  COPD Ctr, Dept Resp Med \& Allergol,Inst Med, Vita Straket 12, SE-41345 Gothenburg,
  Sweden.

  Buttery, Sara C.; Hopkinson, Nicholas S., Imperial Coll London, Natl Heart \& Lung
  Inst, London, England.

  Zysman, Maeva, Univ Bordeaux, Ctr Rech Cardiothorac Bordeaux, Pessac, France.

  Zysman, Maeva, CHU Bordeaux, Serv Malad Resp, Ave Magellan, F-33604 Pessac, France.

  Vikjord, Sigrid A. A., Nord Trondelag Hosp Trust, Levanger Hosp, Dept Med \& Rehabil,
  Levanger, Norway.

  Vikjord, Sigrid A. A., Norwegian Univ Sci \& Technol NTNU, Fac Med \& Hlth Sci,
  HUNT Res Ctr, Dept Publ Hlth \& Nursing, Levanger, Norway.

  Jenkins, Christine, George Inst Global Hlth, Resp Grp, Sydney, NSW, Australia.

  Vanfleteren, Lowie E. G. W., Sahlgrens Univ Hosp, COPD Ctr, Dept Resp Med \& Allergol,
  Gothenburg, Sweden.

  Vanfleteren, Lowie E. G. W., Univ Gothenburg, Sahlgrenska Acad, Inst Med, Dept Internal
  Med \& Clin Nutr, Gothenburg, Sweden.'
author: Buttery, Sara C. and Zysman, Maeva and Vikjord, Sigrid A. A. and Hopkinson,
  Nicholas S. and Jenkins, Christine and Vanfleteren, Lowie E. G. W.
author-email: 'maeva.zysman@chu-bordeaux.fr

  n.hopkinson@ic.ac.uk

  lowie.vanfleteren@gu.se'
author_list:
- family: Buttery
  given: Sara C.
- family: Zysman
  given: Maeva
- family: Vikjord
  given: Sigrid A. A.
- family: Hopkinson
  given: Nicholas S.
- family: Jenkins
  given: Christine
- family: Vanfleteren
  given: Lowie E. G. W.
da: '2023-09-28'
doi: 10.1111/resp.14032
earlyaccessdate: MAR 2021
eissn: 1440-1843
files: []
issn: 1323-7799
journal: RESPIROLOGY
keywords: 'frailty; inequality; patient perspective; patient\&\#8208; reported

  outcome measure; symptoms'
keywords-plus: 'OBSTRUCTIVE PULMONARY-DISEASE; QUALITY-OF-LIFE; BLOOD-PRESSURE

  TRAJECTORIES; ALL-CAUSE MORTALITY; BODY-MASS INDEX; LUNG-FUNCTION;

  PHYSICAL-ACTIVITY; CHRONIC-BRONCHITIS; PRIMARY-CARE; DEVELOPMENTAL

  ORIGINS'
language: English
month: MAY
number: '5'
number-of-cited-references: '255'
orcid-numbers: 'Jenkins, Christine/0000-0003-2717-5647

  ZYSMAN, Maeva/0000-0003-1459-2409

  Buttery, Sara/0000-0001-9410-414X

  Vanfleteren, Lowie/0000-0002-4387-4096'
pages: 419-441
papis_id: 2c387d7a48355931411eaf1fc01f7d92
ref: Buttery2021contemporaryperspect
researcherid-numbers: 'ZYSMAN, Maéva/ACP-5812-2022

  OMOSIGHO, BLESSING/ISS-7818-2023

  '
tags:
- review
times-cited: '14'
title: 'Contemporary perspectives in COPD: Patient burden, the role of gender and
  trajectories of multimorbidity'
type: Review
unique-id: WOS:000626772700001
usage-count-last-180-days: '4'
usage-count-since-2013: '17'
volume: '26'
web-of-science-categories: Respiratory System
year: '2021'