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
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