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n CHRONIC OBSTRUCTIVE PULMONARY DISEASE
to correct perceptions and help blacks seek
appropriate treatment earlier.”
Shifting Susceptibility
COPD is no longer a ‘white man’s problem’
By Valerie Neff Newitt
White meN once had the dubious
distinction of “owning” chronic
obstructive pulmonary disease. Not
any more. COPD has widened its grip, constricting
airways of blacks and females as they
embrace smoking with the same fervor as did
white males half a century ago.
The public misperception that COPD primarily
strikes caucasian men has only added to the
problem. Pulmonologist Jermaine Jackson, MD,
sees a diverse patient population in his practice
at Georgia Lung Associates, Austell, Ga. “What
I observe is this: African Americans with COPD
are younger and have more severe disease than
white counterparts.”
And while his patients may realize smoking
causes heart and lung problems, “… they think
they are immune to COPD. I hear, ‘I didn’t think
that was applicable to me. This is not an African
American problem; it’s a white man’s problem. I
just thought I was getting older,’” Dr. Jackson
said. “By the time an African American patient
gets to me, in early to mid-50s, he is already in
severe COPD. We in health care are challenged
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The leap to statistical data
That anecdotal snapshot on the COPD ethnic/
gender chasm is backed up by hard data, subject
to interpretation.
“If we look at the incidence of COPD and
mortality rates over the last century, they track
according to when different demographics actually
started smoking,” said Mark Dransfield,
MD, of Birmingham, Ala., who spoke May 16
before the American Thoracic Society 2011
International Conference in Denver on the topic
of “Racial Disparities in COPD.”
In the 1900s, the first group to start smoking
heavily was white men. Next, white women
started smoking in numbers, followed by black
men, then black women. The effects on disease
frequency and death, Dransfield said, become
evident 30 to 50 years later.
But on top of increased smoking habits, is
there a superimposed increased susceptibility for
COPD among women and African Americans,
causing their current statistical numbers to catch
up with those of white males
“It depends on what study you look at,”
Dr. Dransfield said. “Some suggest there could
be differences in nicotine metabolism — that
it’s easier for African Americans to become
addicted to cigarettes. But we don’t know yet
if that’s definitively true.”
There is also a persistent hypothesis suggesting
a female’s airway caliber is narrower than
a male’s, thus a similar injury from smoking
would result in more airway obstruction for
women than men. Again, this idea is likely to
be true, but not yet proven.
“If you look at cross-sectional studies, you
find at the same level of lung function impairment,
women and African Americans have
smoked less and tend to be younger,”
Dr. Dransfield said. “At 60 percent of lung
function left, the average woman would be
several years younger than the average man with
the same level of lung function.”
He also pointed to studies that appear to show
differences between races in the distribution of
the emphysema that they get. “Looking at people
with very advanced COPD who were being
evaluated for lung transplant, we’ve seen that
African Americans have less emphysema and the
pattern is different than that seen in whites. So
it looks like the biological response to smoke
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