A new study challenges long-held beliefs about the causes of chronic obstructive pulmonary disease (COPD), revealing that women are significantly more at risk for the condition than men—even though they smoke less. Published in the journal BMJ Open Respiratory Research on May 8, the study found that women are nearly 50 per cent more likely to develop COPD than men, despite having lower smoking rates and smoking less intensively. The findings suggest that smoking alone does not explain the gender disparity in COPD cases and points to other potential environmental or biological factors at play.

COPD is a progressive lung disease that includes chronic bronchitis and emphysema. Tobacco smoking has long been regarded as the primary cause of COPD, but this new research urges a broader look at other contributing elements, particularly among women.

Led by Dr. Alexander Steinberg, assistant professor of clinical practice at the University of Washington in Seattle, the research team analyzed data from over 23,000 adults aged 40 and above who participated in the National Health Interview Survey conducted by the U.S. Centers for Disease Control and Prevention. The sample included approximately 12,600 women and 10,400 men.

The analysis revealed that women were less likely to be current or former smokers, and among those who did smoke, they consumed fewer cigarettes daily and smoked for a shorter duration than their male counterparts. Yet, the prevalence of COPD was higher among women—7.6% compared to 6.4% in men.

Interestingly, among individuals with COPD, women were nearly twice as likely as men to have never smoked—26.6% versus 14.2%. This gender gap persisted even after accounting for variables like age, race, and socioeconomic status. Even among non-smokers, women had a 62% higher likelihood of being diagnosed with COPD compared to men. Among ever-smokers, the increased risk for women was still evident at 43%.

These findings cast doubt on the previous hypothesis that women are simply more biologically vulnerable to tobacco smoke. “The higher risk of COPD in women was not explained by higher susceptibility to cigarette smoke,” the researchers wrote. In fact, the risk of developing COPD per 10 pack-years of smoking was almost identical between the sexes. Pack years is a metric used to quantify smoking exposure over time.

The study’s authors suggest several alternative explanations for the increased COPD risk among women. These include greater exposure to indoor air pollutants from household cleaning products, aerosolised beauty products, and cooking or heating methods that produce harmful fumes—environments where women have historically spent more time. Biological differences, such as smaller lung airways in women, could also contribute to their heightened vulnerability to lung damage.

“Our research raises uncertainty about the common assumption that increased vulnerability to cigarette smoke is driving the gender divide in COPD,” the researchers concluded, emphasising the need for further investigation into environmental, occupational, and physiological factors that may uniquely affect women's respiratory health.

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