Chronic obstructive pulmonary disease natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Philip Marcus, M.D., M.P.H. [2]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [3]; Tarek Nafee, M.D. [4], Mehrian Jafarizade, M.D [5]
Overview
COPD is a slowly progressive disease that may lead to death. The rate at which it gets worse varies between individuals. The factors that predict a poorer prognosis are severe airflow obstruction (low FEV1), poor exercise capacity, shortness of breath, significantly underweight or overweight, complications like respiratory failure or corpulmonale, continued smoking, frequent acute exacerbations. Prognosis in COPD can be estimated using the Bode Index. This scoring system uses FEV1, body-mass index, 6-minute walk distance, and the modified MRC dyspnea scale to estimate outcomes in COPD. There is no cure for COPD. However, COPD can be managed and disease progression can be mitigated. Prognosis depends largely on the timing of diagnosis. Its complications include, recurrent pneumonia, cor pulmonale, anemia, depression, and even respiratory failure.
Natural History
COPD is slowly progressive disease that may lead to death. The rate at which it gets worse varies between individuals. Depending on the severity of the disease and the degree of acute desaturation, if left untreated, patients may experience severe dyspnea, hypercapnia, hypoxemia, and death. In the absence of an acute exacerbation, COPD patients may have a prolonged, insidious course that may result in neurological manifestations of chronic mild to moderate hypoxemia such as cognitive deficit, depression, anxiety, brain atrophy.
Complications
Common complications of COPD include:
- Recurrent pneumonia: chronic inflammation and airways damage predispose chronic bronchitis patients to recurrent pneumonia either viral or bacterial infections. Additionally, chronic use of inhaled corticosteroids may cause recurrent infections[1]
- Depression: may require psychiatry consultation[2]
- Cor pulmonale: chronic hypoxia and subsequent vasoconstriction in pulmonary vasculature results in pulmonary hypertension and right sided heart failure, termed cor pulmonale[3]
- Anemia: anemia of chronic disease may develop in this patients and indicates a poor prognosis.
- Polycythemia: secondary to chronic hypoxemia, Hematocrit level may rise up to 60 (normal range: adult men: 46±4, adult women:40±4).
- Inability to perform functional activities of daily living (ADL)
- Moderate to severe dyspnea
- Respiratory failure
- Cognitive deficit
- Severe hypoxemia leading to coma or death.
Prognosis
A good prognosis of COPD relies on an early diagnosis and prompt treatment. Majority of patients will have improvement in lung function once treatment is started, owever eventually signs and symptoms will worsen as COPD progresses. The median survival is about 10 years if two-thirds of expected lung function was lost by diagnosis.
- The most important prognostic factor is the FEV1 level.
- Other determining factors include:[4]
- Cigarette smoking
- BMI ≤ 21
- Decreased exercise capacity
- Increased C-reactive protein level
- Co-morbid diseases.
Chronic bronchitis
Chronic bronchitis however is dependent on early recognition and smoking cessation which improves the outcome significantly.
Emphysema
The outcome is better for patients with less damage to the lung who stop smoking immediately. Still, patients with extensive lung damage may live for many years so predicting prognosis is difficult. Death may occur from respiratory failure, pneumonia, or other complications.
References
- ↑ Singh S, Amin AV, Loke YK (2009). "Long-term use of inhaled corticosteroids and the risk of pneumonia in chronic obstructive pulmonary disease: a meta-analysis". Arch. Intern. Med. 169 (3): 219–29. doi:10.1001/archinternmed.2008.550. PMID 19204211.
- ↑ Ohayon MM (2014). "Chronic Obstructive Pulmonary Disease and its association with sleep and mental disorders in the general population". J Psychiatr Res. 54: 79–84. doi:10.1016/j.jpsychires.2014.02.023. PMID 24656426.
- ↑ Klinger JR, Hill NS (1991). "Right ventricular dysfunction in chronic obstructive pulmonary disease. Evaluation and management". Chest. 99 (3): 715–23. PMID 1995228.
- ↑ Vanfleteren LE, Spruit MA, Wouters EF, Franssen FM (2016). "Management of chronic obstructive pulmonary disease beyond the lungs". Lancet Respir Med. doi:10.1016/S2213-2600(16)00097-7. PMID 27264777.