prognosis

Last edited 12/2018

• if in a middle-aged patient the FEV1 is 1 litre below the expected value then the patient is very likely to become disabled by airways obstruction unless they stop smoking.
• if a patient stops smoking then the rate of deterioration of FEV1 reverts back to that which normally would occur with advancing age, thus improving prognosis.
• there is a mortality rate of 10% per year once the FEV1 approaches 1 litre.
• prognosis is better if the predominant pathology is that of mucus hypersecretion than those patients in which airways obstruction predominates.
• if there is the development of cor pulmonale and pulmonary hypertension then the 5 year survival is about 30%.
• weight loss is associated with considerably increased morbidity and mortality.

NICE guidance suggest that a

• disability in COPD can be poorly reflected in the FEV1.  A more comprehensive assessment of severity includes the degree of airflow obstruction and disability, the frequency of exacerbations and the following known prognostic factors:
• FEV1
• TLCO
• breathlessness (MRC scale)
• health status
• exercise capacity (for example, 6-minute walk test)
• BMI
• partial pressure of oxygen in arterial blood (PaO2)
• cor pulmonale (1)

Reference:

• (1) NICE. Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update). Clinical guideline No. 101. June 2010