Introduction Despite significant declines in cigarette use over the last 50 years, chronic obstructive pulmonary disease (COPD) remains a leading cause of mortality in the USA.1 While cigarette smoking has decreased significantly among both men and women over that time, smoking rates are declining more slowly for women2 3 and the prevalence of COPD among women is approaching that of men.46 Projections of COPD prevalence to 2050 suggest this trend will continue.7 Compared with men, women have more early-onset severe COPD,8 9 more severe dyspnoea, more frequent exacerbations and worse quality of life for a given percent decrease in airflow on spirometry.9 10 Women with COPD are younger on average and have a lower average pack-year smoking exposure than men.912 This has raised the question of whether women are more susceptible to cigarette smoke.13 Indeed, prior work has suggested that the dose-response relationship between smoking and COPD may vary by gender, with a more rapid decline in airflow seen in women.12 14 However, other studies have shown no difference in the progression of airflow obstruction by gender.15 16 Only very limited research has focused on COPD in adults who have never smoked cigarettes, but overall suggests higher rates of COPD among women compared with men.1720 To further elucidate the relationship between gender, cigarette smoke exposure and COPD and to update prior estimates of the prevalence and burden of disease, we used a large nationally representative dataset to determine whether the association between cigarette exposure and COPD prevalence differs by gender
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