Prognosis in Chronic Obstructive Pulmonary Disease^1–3

Abstract

We recruited 985 patients with COPD but without hypoxemia or other serious disease, treated them in a standard fashion, and followed them closely for nearly 3 yr. At the time of recruitment the patients were carefully characterized as to symptom severity, lung function, exercise tolerance, and quality of life, and studies of lung function were repeated during follow-up. Overall mortality was 23% in 3 yr of follow-up. Patient age and the initial value of the FEV1 were the most accurate predictors of death; when FEV1 before bronchodilator was used, the response to bronchodilators was directly related to survival, but this relationship became nonsignificant when postbronchodilator FEV1 was used as a primary predictor. After adjustment for age and FEV1, mortality was related positively to TLC, resting heart rate, and perceived physical disability, and related negatively to exercise tolerance. These relationships, though significant, were relatively weak. When standardized for age and FEV1, mortality in the present series was less than that of a previous series (4), and the same as that of hypoxemic patients with COPD who received continuous home O2 therapy. Changes in FEV1 with time averaged -44 ml/yr, but the standard deviation was large. Patients with low initial values of FEV1 showed relatively little further decline, probably indicating a survivor effect. In patients with well-preserved initial FEV1, rate of decline correlated negatively with bronchodilator response, symptomatic wheezing, and psychological disturbances.

Are COPD Patients with Nocturnal REM Sleep-Related Desaturations More Prone to Developing Chronic Respiratory Failure Requiring Long-Term Oxygen Therapy?

“…The significance of PaCO 2 levels is more controversial. Several authors have found PaCO 2 to be a useful predictor of mortality [17, 20, 21], but other studies have not confirmed these results [18, 22]. The range of PaCO 2 in our series of patients was very narrow, the mean value being 40.4 mm Hg with a standard deviation of 3.1 mm Hg; the maximum value of PaCO 2 was 46 mm Hg (4 patients).…”

“…The degree of airway obstruction, expressed by FEV 1 , is well known to correlate with survival: the higher the FEV 1 value at the time of selection, the lower the risk of COPD-related death [17, 18, 19]. The significance of PaCO 2 levels is more controversial.…”

Characteristics and survival of patients prescribed long-term oxygen therapy outside prescription guidelines

“…This could reflect the beneficial effect of LTOT in hypoxaemic patients in improving the survival into the same range as that of patients with a Pa,O 2 >8 kPa. ANTHONISEN et al [21] showed that oxygen therapy improved survival in patients with a Pa,O 2 7.3 kPa (55 mmHg) to the same level as in patients with a similar level of obstruction but without hypoxaemia (Pa,O 2 Š7.3 kPa). Randomized, controlled trials with welldefined groups of patients and an assessment of quality of life, healthcare consumption and costs are needed.…”

“…FEV1 is independently predictive of survival even when mildly impaired [21]. COOPER and HOWARD [22] have shown that deterioration in airway function continues despite LTOT and thus reduces survival.…”

Relationship of Metabolic Alkalosis, Azotemia and Morbidity in Patients with Chronic Obstructive Pulmonary Disease and Hypercapnia

“…In COPD patients, FEV 1 , age, PaCO 2 , cardiac disease, long duration of mechanical ventilation and body mass index have been reported as the main factors affecting mortality [2,3,4,5,19,20,21,22,23,24,25]. In our previous study involving COPD patients with hypercapnic respiratory failure, among the variables that were shown to influence mortality, there were the need for intubation and complications of invasive mechanical ventilation [6].…”