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COPD (Chronic Obstructive Pulmonary Disease)

Stage of COPD & prognosis

02/18/2009

Question:

MY SPOUSE HAS EXHIBITED INCREASED COUGHING,CHOKING,WHEEZING, MUCUS PRODUCTION OVER PAST MONTH. ALSO INCREASED COMPLAINTS OF CHEST PAIN,WAKING UP WITH HEADACHES ALMOST DAILY AND NOT FEELING RESTED EVEN AFTER SLEEPING FOR MOST OF DAY. SAW PULMONOLOGIST AND WAS TOLD THAT AGE 50 IT WAS THE WORSE CASE OF COPD HE HAD EVER SEEN IN SOMEONE SO YOUNG.SPOUSE HAS SMOKED FOR MORE THAN 20 YRS AND CONTINUES TO DO SO, PLANS TO TRY AND QUIT SOON. MEANWHILE HE HAS BEEN PUT ON OXYGEN THERAPY AND CLASSIFIED AS STAGE 3 GOING INTO STAGE 4. PFT SHOW HIM TO HAVE 20% LUNG FUNCTION. COULD A EDUCATED GUESS AT HIS PROGNOSIS BE GIVEN.

Answer:

Thank you for visiting NetWellness and for your question. Some information is available on prognosis in COPD patients, but the information is limited.

Traditionally, prognosis has been reported based on the FEV1, which is a part of pulmonary function testing. An FEV1 of less than 35% of predicted means very severe disease and some studies estimate that more than half of patients with very severe disease may not be expected to survive for four years.

In addition to the FEV1, other factors that predict prognosis are the person's weight (very low weight is bad in this case), their distance walked in six minutes, and their degree of shortness of breath with activities. These factors are called the BODE index and can be used to provide information on prognosis for one-year, two-year, and four-year survival.

For example, a person who has lung impairment with an FEV1 of 20%, shortness of breath when getting dressed, and the ability to walk only 500 feet in 6 minutes has a two-year survival rate of 69%. That means based on studies to date, 31 out of 100 similar people will not survive two years. The factors known to improve survival are smoking cessation and oxygen therapy.

Reference:

Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. New England Journal of Medicine. 2004 Mar 4;350(10):1005-12.

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Response by:

Michael E Ezzie, MD Michael E Ezzie, MD
Clinical Assistant Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University