A new cross-sectional survey published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation highlights significant sex-based disparities in the diagnosis, management, and lived experiences of patients with COPD, bronchiectasis, and nontuberculous mycobacterial lung disease.1
Led by Radmila Choate, PhD, MPH, Associate Professor of Epidemiology at the University of Kentucky College of Public Health, the study analyzed responses from 632 individuals with self-reported lung disease (74% women) recruited via the COPD Foundation’s online platform. The mean age of included patients was 70 years, with 68% reporting diagnoses of COPD and 32% bronchiectasis.
“Very little work has explored how sex shapes symptom recognition, communication with clinicians, treatment conversations, and the practical and emotional challenges of living with chronic lung conditions, such as COPD and bronchiectasis,” Dr. Choate said. “Our goal was to capture these lived experiences in a way that helps clinicians recognize patterns that differ for women and men and adapt care more thoughtfully.”
The investigators found that time from onset of symptoms to first health care visit differed between men and women with COPD and bronchiectasis. In bronchiectasis, 47% of women sought care within six months of symptom onset compared with 36% of men. The time from the first health care visit to a confirmed diagnosis was reversed, however, with only 31% of women with bronchiectasis receiving a confirmed diagnosis within six months compared with 52% of men (P = .0376). In respondents with COPD, a statistically significant 43% of women vs 29% of men (P = .0078) sought care within six months of symptom onset. Despite the difference, the proportions were similar for confirmed diagnosis within six months (55% of women and 60% of men).
In the bronchiectasis group, more women were diagnosed during evaluation for another condition compared with men (35% vs 28%), while significantly more men were diagnosed during hospitalization (36% vs 16%).
The survey also revealed a higher psychological burden among women. Seventy-eight percent of women with COPD reported anxiety, depression, or fear related to their diagnosis, compared with 66% of men.
“Several factors likely contribute, including long-standing assumptions about who develops COPD, inconsistent use of spirometry, and missed opportunities to identify emotional distress during routine visits,” Dr. Choate said. She added that the team also observed related patterns in bronchiectasis, although the magnitude varied.
“Health systems can respond by standardizing diagnostic pathways for both women and men, expanding timely access to objective pulmonary testing, and embedding mental health screening and support directly into pulmonary care,” she said.
A striking finding was that more than one-third of postmenopausal women reported worsening pulmonary symptoms during the transition to menopause. These women also had higher Chronic Airways Assessment Test scores, indicating a greater impact of lung disease on overall health.
“Menopause should be part of routine clinical conversation,” Dr. Choate said. “Asking about the timing of hormonal transitions and tracking changes in pulmonary symptoms can give clinicians important context for treatment decisions. Longitudinal studies are needed to clarify how hormonal changes influence inflammation, respiratory symptoms, and disease progression in both COPD and bronchiectasis.”
The study found that perceived treatment burden decreased with age, but multimorbidity remained common, especially among those with COPD. Osteoarthritis was the most prevalent comorbidity in women, while coronary artery disease was most common in men. Fatigue and weight loss were frequently reported, with women experiencing higher levels of the former. Social support emerged as a critical factor, yet 19% of women with COPD and 22% of men with bronchiectasis reported lacking a support system. Financial strain was also prevalent, affecting more than half of respondents with COPD.
The authors said the findings highlight the need for clinicians to recognize sex-based differences in symptom presentation, diagnostic delays, and psychological impact. Incorporating menopause status, mental health screening, and social support into routine care can improve outcomes for patients with COPD and bronchiectasis.
“Integrating mental health specialists, social workers, rehabilitation teams, and patient navigators can address emotional well-being, functional limitations, and financial stress at the same time,” Dr. Choate said. “Coordinated care that brings these services together can make a real difference in daily quality of life, as most patients do better when support extends beyond the respiratory system.”
References
1. Choate R, Aksamit TR, Torrence J, et al. Navigating COPD and bronchiectasis: A COPD Foundation survey of differences in patient-perceived health care experiences by sex. Chronic Obstr Pulm Dis. 2025;12(5):399-410. doi:10.15326/jcopdf.2025.0620
