A silent killer in Wisconsin is starting to stalk women more than men.

It goes by a relatively new name - chronic obstructive pulmonary disease - but has an old cause, cigarette smoking, in 85 percent of the cases. Doctors and officials from the Wisconsin Public Health and Health Policy Institute and the American Lung Association of Wisconsin released a report on COPD on Monday at the State Capitol. They said that in the past 20 years, deaths of Wisconsin women from COPD - an umbrella term for ailments that obstruct airflow to the lungs, including emphysema and chronic bronchitis - more than quadrupled. COPD now ranks as the third leading cause of death among Wisconsin women, after cancer and heart disease, said David Ahrens, research program manager for the University of Wisconsin Comprehensive Cancer Center and a co-author of the report. More than 2,000 Wisconsinites died from this disease in 2001, and an estimated 180,000 state residents have the disease, many of them undiagnosed, Ahrens said. COPD is particularly devastating because people lose the ability to breathe and end up being homebound, said Dr. Nizar Jarjour, a pulmonologist and a volunteer with the American Lung Association. It is a progressive, debilitating, incurable disease that may be little known because those who have the disease are hidden. The Wisconsin study covered the period 1979 to 1998. In 1979, the age-adjusted mortality for men was six times that of women. But by 1998, it fell to 1.8 times. More women now have COPD because more women started smoking after World War II, the report said. Women also may have been exposed to more indoor air pollutants, including secondhand smoke, as they joined the work force, the study said. Women who began and continued smoking in the postwar period fell ill from COPD in the 1970s and 1980s, and died from the disease eight to 10 years later, the report found. "Rates of COPD among men plateaued in 1991 and began to decline, but rates continue to go up among women," said Dr. Patrick Remington, director of the Wisconsin Public Health and Health Policy Institute and a co-author of the report. "Some of the increase is probably due to a greater negative effect on lungs from smoking in women than among men." Research has suggested that cigarette smoking may be more detrimental in its effects on lung function in women than in men, if they smoke at the same rate. "The smoker smokes to get a dose of nicotine. So women who moved to light cigarettes because of tar and nicotine smoke more and inhale deeper," Remington added. He noted that women appear to have a harder time quitting smoking, and more high school girls are smoking than boys. "For women who do not work outside the home, there are fewer pressures to quit," Remington said. "Another aspect relates to fear of weight gain if they stop smoking. Also, the rate of depression is slightly higher in women. People who are depressed have less success in quitting smoking." Currently, the age-adjusted death rate from COPD in Wisconsin men is higher than women, but death rates are rising faster for women, and in the age groups under 65, the death rates for women are already equal to or higher than men of the same age. In the not-so-distant future, COPD may be a predominantly female disease, the study said. According to the Global Initiative on Chronic Obstructive Lung Disease guidelines, 32 percent of people who smoked one pack a day for 10 years or more have undiagnosed COPD. The report suggested four effective strategies for reducing tobacco use: increasing taxes on cigarettes, enforcing indoor clean air policies such as smoking bans, using consistent mass media campaigns and making smoking cessation services available.

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