This apparent paradox may stem from multiple factors: premenopausal women likely benefit from estrogen receptor beta (ERβ)-dominated pulmonary protection, while postmenopausal estrogen decline shifts the balance toward ERα predominance, potentially driving NF-κB activation and Nrf2 suppression linked to increased COPD susceptibility.45 Here, NFKB1 is linked to chronic obstructive pulmonary disease.