Last edited 12/2018

  • if in a middle-aged patient the FEV1 is 1 litre 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
    • TLCO
    • breathlessness (MRC scale)
    • health status
    • exercise capacity (for example, 6-minute walk test)
    • BMI
    • partial pressure of oxygen in arterial blood (PaO2)
    • cor pulmonale (1)