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Prognosis in severe chronic obstructive pulmonary disease.

D S Postma, J Burema, F Gimeno

    The American Review of Respiratory Disease
    |March 1, 1979
    PubMed
    Summary

    This study on severe chronic obstructive pulmonary disease found that the rate of decline in forced expiratory volume in 1 second (FEV1) and its reversibility with bronchodilators predict survival. Continuous medical care may significantly improve outcomes for COPD patients.

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    Area of Science:

    • Pulmonology
    • Clinical Medicine
    • Prognostic Studies

    Background:

    • Severe chronic obstructive pulmonary disease (COPD) poses significant long-term survival challenges.
    • Accurate prognostic markers are crucial for effective patient management and treatment strategies.

    Purpose of the Study:

    • To identify key predictors of long-term survival in patients with severe COPD.
    • To investigate the relationship between lung function decline, bronchodilator response, and survival rates.

    Main Methods:

    • A long-term prognostic study involving 129 patients with severe COPD (initial FEV1 ≤ 1,000 ml).
    • Data collected over multiple visits were analyzed using multiple regression and discriminant analysis.
    • Evaluation of FEV1 changes over time and response to thiazinamium, a bronchodilator.

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    Main Results:

    • Five- and 10-year cumulative survival rates were 69% and 40%, respectively.
    • Survival prediction was primarily determined by the annual rate of FEV1 decrease and bronchodilator-induced FEV1 increase.
    • Initial FEV1 values were predictive only when below 450 ml; various patterns of FEV1 decline were observed, with no sudden drops.

    Conclusions:

    • Greater reversibility of airway obstruction with bronchodilators is associated with better survival in severe COPD.
    • Continuing medical care, particularly addressing reversible airway obstruction, is hypothesized to be crucial for improving survival.
    • While certain factors indicate poor prognosis, comprehensive treatment focusing on reversible obstruction is paramount.