Introduction and Objective In recent years accumulating evidence supports gender differences in COPD, suggesting a steady increase in COPD prevalence and mortality rates in women. In this analysis we evaluated gender differences in COPD exacerbations in a cohort of COPD patients from the Clinical Practice Research Datalink (CPRD), a general practice electronic primary medical care records database in the UK.

Methods This is a retrospective cohort study comparing women and men with an incident diagnosis of COPD, using secondary data from the linkage between the CPRD and the Hospital Episode Statistics (HES) databases. The study period was between 01 January 2005 and 28 February 2016; patients with an incident diagnosis of COPD between 01 January 2010 and 28 February 2015 were included in this study.

Results A cohort of 22,429 COPD patients (48% women) with an incident diagnosis of COPD was identified. At diagnosis, women were younger, more often current or non-smokers and had lower BMI, better lung function (as expressed by FEV₁% predicted), worse mMRC dyspnea scale scores and lower blood eosinophils. Women also had a higher prevalence of asthma, anxiety, depression and osteoporosis, whereas men had more often cardiovascular comorbidities (myocardial infarction, heart failure and atrial fibrillation). The risk of first moderate or severe exacerbation was 17% greater in women than in men (adjusted HR, 1.17; 95% CI, 1.12 to 1.23), with a median time to first exacerbation of 504 days for women and 637 days for men. These gender differences were more prominent in patients aged 40–64 years and in those with moderate-to-severe airflow obstruction (30% ≤ FEV₁<80% predicted). Women also had a greater rate of moderate or severe exacerbations at year 1 (adjusted RR, 1.15; 95% CI, 1.07 to 1.23), year 2 (adjusted RR, 1.14; 95% CI, 1.08 to 1.21) and year 3 (adjusted RR, 1.14; 95% CI, 1.08 to 1.20) of follow-up.

Conclusions Despite evidence for milder disease at the time of COPD diagnosis, women were at greater risk of COPD exacerbations than men, especially at younger ages. These Results highlight the unmet need for appropriate identification and management of women with COPD in clinical practice.