COPD Prognosis: Will My COPD get Worse?

COPD Prognosis: What Will Happen Over Time?

Dear Dr. Mahler: I recently asked my doctor about my COPD prognosis.  His answer was that, “COPD is a progressive disease.” I am 63 years old, and was diagnosed about 5 years ago. I am doing pretty good at the present time, and want to be able to continue my activities as long as possible. However, I am worried that everything will slowly get worse and that I will need oxygen to get around. What are your thoughts? Sam from Hilton Head, SC Dear Sam: The current definition by the GOLD committee states that COPD is “usually progressive.” The word usually was added a few years ago based on new information about the course of COPD as assessed by results of breathing tests (pulmonary function tests) over 3 – 4 years in those with moderate, severe, and very severe COPD. The usual way to evaluate COPD prognosis (Is it getting worse?) is to consider how much air you can blow out (exhale) in one second. This is called FEV1 (see diagram below). One thing to remember is that lung function (FEV1) slowly declines in healthy people because we are getting older. This is due to loss of some of the elastic fibers in the lung tissue.
FEV1 is used to grade COPD severity and assess COPD prognosis

Diagram of spirometry to diagnose COPD. FEV1 is the amount of air exhaled in one second.

A few years ago, two different studies reported FEV1 results in longitudinal studies (those with COPD could continue their usual COPD medications). Both studies found that some individuals with COPD had stable FEV1 values over time, while another group of individuals with COPD showed that FEV1 became lower or worse. A recent study published by Dr. Lange and colleagues in the July 9, 2015, issue of the New England Journal of Medicine sheds further light on your question. The researchers analyzed three different studies that measured FEV1 for decades. They found that one group who developed COPD started with low values for FEV1 in early adulthood and showed a normal decline in FEV1 due to aging. This means that a low value for FEV1 in early adulthood may be an important starting point for some individuals with COPD and that their lung condition may not worsen any more than what occurs with getting older. How will you know this? Certainly, we can’t go back and know what you breathing tests were when you were 25 years old. But, we can follow the results of your breathing tests every 6 – 12 months to observe whether the FEV1 is stable, slowly declining as expected with age, or actually declining faster than expected due to COPD. You can ask your doctor about any changes in your FEV1 over the past few years. Remember Sam, the most important thing that you can do to protect your lungs and keep them healthy is to not smoke and to avoid inhaling irritants (fumes, dust, fibers, etc.) in the air. Finally, no one has a crystal ball to predict the future. It is important to stay active, eat healthy, maintain a normal body weight, avoid too much stress, and sleep 7 – 8 hours each night. Sincerely, Donald A. Mahler, M.D.  

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.