We examined the course and prognosis in subjects selected from the general population who had chronic airflow obstruction at the time of their enrollment in a longitudinal epidemiologic study. Mortality and the rate of change in lung function were analyzed in relation to the initial clinical characteristics of the subjects. Twenty-seven subjects with symptoms and signs of asthma (Group I) had a higher survival rate and a much lower rate of decline in pulmonary function than the 45 subjects in Group III, whose clinical characteristics were more compatible with an emphysematous form of chronic obstructive pulmonary disease (COPD). The 10-year mortality among subjects in Group III (non-atopic smokers without a history of asthma) was close to 60 percent, whereas it was only 15 percent in Group I (atopic subjects or nonsmokers with known asthma). The mean overall rate of decline in forced expiratory volume in one second was 70 ml per year in Group III but less than 5 ml per year in Group I. Forty-five patients (Group II) who did not clearly fit into either Group I or III had intermediate values for survival and decline in pulmonary function. Previous data on mortality from COPD and the rate of progression of the condition, although compatible with our findings in patients who had an emphysematous form of disease, are not applicable to those with an asthmatic-bronchitic form. Better control of the progression of asthmatic bronchitis with therapy may explain its more favorable prognosis.

This study employed secondary data analysis to explore family perceptions of adjustment and social behaviour in older adults (n = 51) with chronic obstructive pulmonary disease (COPD) and their relationship to published norms and patient self-report. According to the Katz Adjustment Scale for Relatives, these COPD patients had significantly higher levels of belligerence, negativism, helplessness, withdrawal, psychopathology, nervousness and confusion than reports from relatives of older adults from the general population. No differences were found in performance, expectation or dissatisfaction with socially expected activities, or performance of free-time activities. However, family members of COPD patients were significantly more dissatisfied with their relative's free-time activities. Although family perceptions of socially expected activities corresponded to patient descriptions of general and physical functioning (Sickness Impact Profile), patient perceptions of psychosocial functioning were independent of the family's. The results supported the tenet that older adults with COPD have difficulties with adjustment that may adversely affect social relationships, but were not consistent with the belief that the performance of socially expected or free-time activities is more impaired than in others of this age group. The data also suggested there may be some perceptual discrepancy between family and patient views of social behaviour.

The purpose of this study was to compare the functional performance profiles of men and women with chronic obstructive pulmonary disease, describe the extent to which physiologic impairment, physical symptoms, and psychosocial resources contribute in a cumulative manner to performance, and outline the extent to which these contributions differ across gender. Secondary data analyses were employed. Although women (n = 45) reported more functional difficulty than men (n = 44) in 9 of 12 Sickness Impact Profile categories, the differences were not significant. Using hierarchical regression procedures, physiologic, symptomatic, and interactive variables predicted total (R2 = .64) and physical performance (R2 = .52), while symptomatic and psychosocial variables predicted psychosocial performance (R2 = .53). Results indicate that models of functional performance may be different for men and women.

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