COPD Prognosis

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Chronic obstructive pulmonary disease concept
When someone is diagnosed with a condition such as chronic obstructive pulmonary disease (COPD), it’s natural to worry about the condition’s impact on life expectancy. There are various factors that make it impossible for a doctor to predict exactly how a patient’s disease will play out and what their life expectancy will be.

Some of the factors that influence COPD prognosis include:

  •  The stage of COPD; the higher the stage, the worse the prognosis
  •  Whether or not the patient quits smoking
  • Other existing medical conditions, such as heart disease
  • The patient’s lifestyle and overall health
  • How the patient will respond to treatment

Stages of COPD

Assessing the stage of the condition can help doctors better predict a COPD patient’s outlook. The most commonly used staging system is the GOLD classification by the Global Initiative for Chronic Obstructive Lung Disease. With this system, severity and stage of the disease are determined by a test that calculates the forced expiratory volume (FEV1). This is the amount of air the patient can forcefully exhale.

The stages are determined as follows:

Stage 1: Mild with an FEV1 of about 80 percent or more. At this stage, the patient may not be aware of the symptoms.

Stage 2: Moderate with an FEV1 between 50 and 80 percent. Symptoms progress, often causing shortness of breath on exertion.

Stage 3: Severe, with an FEV1 between 30 and 50 percent. Shortness of breath worsens and may limit daily activities. Exacerbations begin or become more frequent.

Stage 4: Very severe, with an FEV1 lower than in stage three. Patients may also be stage three plus suffer from chronic respiratory failure. Quality of life is significantly reduced and exacerbations are more likely to be life-threatening.

BODE Index

A newer method used to help determine COPD prognosis, which some consider to be more accurate at predicting risk of death from COPD, is the BODE index. This system looks at the overall picture of a patient’s health and the impact that COPD has on their quality of life.
BODE refers to:

  • Body mass: The body mass index (BMI) determines body fatness calculated from a person’s weight to height ratio. In COPD, being too thin worsens the prognosis.
  • Airflow obstruction: This is the amount of air a patient can forcefully expel as determined in the GOLD system.
  • Dyspnea: This refers to difficulty breathing. Several studies have found that those who experience more issues with their breathing may have a worse outcome than those who are better able to breathe.
  • Exercise capacity: This is usually measured by a six-minute walk test that determines how well a patient tolerates physical exertion.While a doctor may not be able to predict exactly how your disease will progress, these systems can provide valuable insight.

A patient may be able to slow the progression of COPD and improve their prognosis by getting treatment as early as possible and making some lifestyle changes. Quitting smoking and avoiding secondhand smoke and other irritants is crucial. Staying active and maintaining a healthy weight may also improve the quality of life and longevity.

1 Global Initiative for Chronic Obstructive Lung Disease. SPIROMETRY FOR HEALTH CARE PROVIDERS. Global Initiative for Chronic Obstructive Lung Disease. Accessed March 19, 2015.2Medscape. BODE Index for COPD Survival Prediction. Medscape. Accessed March 20, 2015.

3Wen Q. Gan, MD, MSc, S.F. Paul Man, MD, FRCPC. Systemic effects and mortality in chronic obstructive pulmonary disease. BCMJ, Vol. 50, No. 3, April 2008, page(s) 148-151. Accessed March 20, 2015.