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Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • if in a middle-aged patient the FEV1 is 1L 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
    • Smoking status
    • breathlessness (MRC scale)
    • chronic hypoxia and/or cor pulmonale
    • low BMI
    • severity and frequency of exacerbations
    • hospital admissions
    • symptom burden (COPD Assessment Test (CAT) score)
    • exercise capacity (for example, 6-minute walk test)
    • TLCO
    • Whether the person meets the criteria for long-term oxygen therapy and/or home non-invasive ventilation
    • multimorbidity
    • frailty


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