Chronic obstructive pulmonary disease: Prognostic factors and comorbid conditions
- Scott T Weiss, MD, MS
Scott T Weiss, MD, MS
- Professor of Medicine
- Harvard Medical School
A variety of clinical factors are thought to influence the natural history and prognosis of patients with chronic obstructive pulmonary disease (COPD) [1-3]. These factors and the impact of acute exacerbations on disease outcome will be reviewed here.
The diagnosis and management of COPD are discussed elsewhere. (See "Chronic obstructive pulmonary disease: Definition, clinical manifestations, diagnosis, and staging" and "Management of exacerbations of chronic obstructive pulmonary disease" and "Management of stable chronic obstructive pulmonary disease".)
A number of factors have been identified as prognostic indicators for COPD. In addition to the forced expiratory volume in one second (FEV1), other predictors of accelerated lung function decline, diminished physical function, and/or mortality in patients with COPD include [4-14]:
- Dolan S, Varkey B. Prognostic factors in chronic obstructive pulmonary disease. Curr Opin Pulm Med 2005; 11:149.
- Centers for Disease Control and Prevention (CDC). Deaths from chronic obstructive pulmonary disease--United States, 2000-2005. MMWR Morb Mortal Wkly Rep 2008; 57:1229.
- Ford ES. Trends in mortality from COPD among adults in the United States. Chest 2015; 148:962.
- Celli BR, Cote CG, Marin JM, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004; 350:1005.
- Heffner JE, Mularski RA, Calverley PM. COPD performance measures: missing opportunities for improving care. Chest 2010; 137:1181.
- Hospers JJ, Postma DS, Rijcken B, et al. Histamine airway hyper-responsiveness and mortality from chronic obstructive pulmonary disease: a cohort study. Lancet 2000; 356:1313.
- Diaz PT, King MA, Pacht ER, et al. Increased susceptibility to pulmonary emphysema among HIV-seropositive smokers. Ann Intern Med 2000; 132:369.
- Wilkinson TM, Patel IS, Wilks M, et al. Airway bacterial load and FEV1 decline in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2003; 167:1090.
- Berry MJ, Adair NE, Rejeski WJ. Use of peak oxygen consumption in predicting physical function and quality of life in COPD patients. Chest 2006; 129:1516.
- Dahl M, Vestbo J, Lange P, et al. C-reactive protein as a predictor of prognosis in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2007; 175:250.
- Drummond MB, Blackford AL, Benditt JO, et al. Continuous oxygen use in nonhypoxemic emphysema patients identifies a high-risk subset of patients: retrospective analysis of the National Emphysema Treatment Trial. Chest 2008; 134:497.
- de Torres JP, Cote CG, López MV, et al. Sex differences in mortality in patients with COPD. Eur Respir J 2009; 33:528.
- Kohansal R, Martinez-Camblor P, Agustí A, et al. The natural history of chronic airflow obstruction revisited: an analysis of the Framingham offspring cohort. Am J Respir Crit Care Med 2009; 180:3.
- Haruna A, Muro S, Nakano Y, et al. CT scan findings of emphysema predict mortality in COPD. Chest 2010; 138:635.
- Traver GA, Cline MG, Burrows B. Predictors of mortality in chronic obstructive pulmonary disease. A 15-year follow-up study. Am Rev Respir Dis 1979; 119:895.
- Vestbo J, Edwards LD, Scanlon PD, et al. Changes in forced expiratory volume in 1 second over time in COPD. N Engl J Med 2011; 365:1184.
- Drummond MB, Hansel NN, Connett JE, et al. Spirometric predictors of lung function decline and mortality in early chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2012; 185:1301.
- Miniati M, Monti S, Pavlickova I, Bottai M. Survival in COPD: impact of lung dysfunction and comorbidities. Medicine (Baltimore) 2014; 93:e76.
- Casanova C, de Torres JP, Aguirre-Jaíme A, et al. The progression of chronic obstructive pulmonary disease is heterogeneous: the experience of the BODE cohort. Am J Respir Crit Care Med 2011; 184:1015.
- Nishimura M, Makita H, Nagai K, et al. Annual change in pulmonary function and clinical phenotype in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2012; 185:44.
- Ong KC, Earnest A, Lu SJ. A multidimensional grading system (BODE index) as predictor of hospitalization for COPD. Chest 2005; 128:3810.
- Martinez FJ, Han MK, Andrei AC, et al. Longitudinal change in the BODE index predicts mortality in severe emphysema. Am J Respir Crit Care Med 2008; 178:491.
- Wilson DO, Rogers RM, Wright EC, Anthonisen NR. Body weight in chronic obstructive pulmonary disease. The National Institutes of Health Intermittent Positive-Pressure Breathing Trial. Am Rev Respir Dis 1989; 139:1435.
- Gray-Donald K, Gibbons L, Shapiro SH, et al. Nutritional status and mortality in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996; 153:961.
- Schols AM, Slangen J, Volovics L, Wouters EF. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 157:1791.
- Landbo C, Prescott E, Lange P, et al. Prognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 160:1856.
- Prescott E, Almdal T, Mikkelsen KL, et al. Prognostic value of weight change in chronic obstructive pulmonary disease: results from the Copenhagen City Heart Study. Eur Respir J 2002; 20:539.
- Vestbo J, Prescott E, Almdal T, et al. Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study. Am J Respir Crit Care Med 2006; 173:79.
- Ischaki E, Papatheodorou G, Gaki E, et al. Body mass and fat-free mass indices in COPD: relation with variables expressing disease severity. Chest 2007; 132:164.
- Martinez FJ, Foster G, Curtis JL, et al. Predictors of mortality in patients with emphysema and severe airflow obstruction. Am J Respir Crit Care Med 2006; 173:1326.
- Gunen H, Hacievliyagil SS, Kosar F, et al. Factors affecting survival of hospitalised patients with COPD. Eur Respir J 2005; 26:234.
- Patil SP, Krishnan JA, Lechtzin N, Diette GB. In-hospital mortality following acute exacerbations of chronic obstructive pulmonary disease. Arch Intern Med 2003; 163:1180.
- Connors AF Jr, Dawson NV, Thomas C, et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Am J Respir Crit Care Med 1996; 154:959.
- Costello R, Deegan P, Fitzpatrick M, McNicholas WT. Reversible hypercapnia in chronic obstructive pulmonary disease: a distinct pattern of respiratory failure with a favorable prognosis. Am J Med 1997; 102:239.
- Martin TR, Lewis SW, Albert RK. The prognosis of patients with chronic obstructive pulmonary disease after hospitalization for acute respiratory failure. Chest 1982; 82:310.
- Hudson LD. Survival data in patients with acute and chronic lung disease requiring mechanical ventilation. Am Rev Respir Dis 1989; 140:S19.
- Seneff MG, Wagner DP, Wagner RP, et al. Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease. JAMA 1995; 274:1852.
- Breen D, Churches T, Hawker F, Torzillo PJ. Acute respiratory failure secondary to chronic obstructive pulmonary disease treated in the intensive care unit: a long term follow up study. Thorax 2002; 57:29.
- Ahmadi-Abhari S, Kaptoge S, Luben RN, et al. Longitudinal association of C-reactive protein and lung function over 13 years: The EPIC-Norfolk study. Am J Epidemiol 2014; 179:48.
- de Torres JP, Pinto-Plata V, Casanova C, et al. C-reactive protein levels and survival in patients with moderate to very severe COPD. Chest 2008; 133:1336.
- Stolz D, Christ-Crain M, Morgenthaler NG, et al. Copeptin, C-reactive protein, and procalcitonin as prognostic biomarkers in acute exacerbation of COPD. Chest 2007; 131:1058.
- Sin DD, Man SF. Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. Proc Am Thorac Soc 2005; 2:8.
- Barr RG, Bluemke DA, Ahmed FS, et al. Percent emphysema, airflow obstruction, and impaired left ventricular filling. N Engl J Med 2010; 362:217.
- Watz H, Waschki B, Meyer T, et al. Decreasing cardiac chamber sizes and associated heart dysfunction in COPD: role of hyperinflation. Chest 2010; 138:32.
- Williams MC, Murchison JT, Edwards LD, et al. Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality. Thorax 2014; 69:718.
- Portegies ML, Lahousse L, Joos GF, et al. Chronic Obstructive Pulmonary Disease and the Risk of Stroke. The Rotterdam Study. Am J Respir Crit Care Med 2016; 193:251.
- Takagi H, Umemoto T, ALICE (All-Literature Investigation of Cardiovascular Evidence) Group. A Meta-Analysis of the Association of Chronic Obstructive Pulmonary Disease with Abdominal Aortic Aneurysm Presence. Ann Vasc Surg 2016; 34:84.
- Feary JR, Rodrigues LC, Smith CJ, et al. Prevalence of major comorbidities in subjects with COPD and incidence of myocardial infarction and stroke: a comprehensive analysis using data from primary care. Thorax 2010; 65:956.
- Meteran H, Backer V, Kyvik KO, et al. Comorbidity between chronic obstructive pulmonary disease and type 2 diabetes: A nation-wide cohort twin study. Respir Med 2015; 109:1026.
- Incalzi RA, Corsonello A, Pedone C, et al. Chronic renal failure: a neglected comorbidity of COPD. Chest 2010; 137:831.
- Ferguson GT, Calverley PMA, Anderson JA, et al. Prevalence and progression of osteoporosis in patients with COPD: results from the TOwards a Revolution in COPD Health study. Chest 2009; 136:1456.
- Bon J, Fuhrman CR, Weissfeld JL, et al. Radiographic emphysema predicts low bone mineral density in a tobacco-exposed cohort. Am J Respir Crit Care Med 2011; 183:885.
- Light RW, Merrill EJ, Despars JA, et al. Prevalence of depression and anxiety in patients with COPD. Relationship to functional capacity. Chest 1985; 87:35.
- Omachi TA, Katz PP, Yelin EH, et al. Depression and health-related quality of life in chronic obstructive pulmonary disease. Am J Med 2009; 122:778.e9.
- Schneider C, Jick SS, Bothner U, Meier CR. COPD and the risk of depression. Chest 2010; 137:341.
- Katz PP, Julian LJ, Omachi TA, et al. The impact of disability on depression among individuals with COPD. Chest 2010; 137:838.
- Kim KU, Park HK, Jung HY, et al. Association of depression with disease severity in patients with chronic obstructive pulmonary disease. Lung 2014; 192:243.
- Hanania NA, Müllerova H, Locantore NW, et al. Determinants of depression in the ECLIPSE chronic obstructive pulmonary disease cohort. Am J Respir Crit Care Med 2011; 183:604.
- Arimura Y, Yamazaki S, Yanagi S, et al. Clinical usefulness of the two-question assessment tool for depressive symptoms in Japanese patients with chronic obstructive pulmonary disease. Lung 2013; 191:101.
- Julian LJ, Gregorich SE, Earnest G, et al. Screening for depression in chronic obstructive pulmonary disease. COPD 2009; 6:452.
- Montserrat-Capdevila J, Godoy P, Marsal JR, et al. Overview of the Impact of Depression and Anxiety in Chronic Obstructive Pulmonary Disease. Lung 2017; 195:77.
- Hung WW, Wisnivesky JP, Siu AL, Ross JS. Cognitive decline among patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009; 180:134.
- Singh B, Parsaik AK, Mielke MM, et al. Chronic obstructive pulmonary disease and association with mild cognitive impairment: the Mayo Clinic Study of Aging. Mayo Clin Proc 2013; 88:1222.
- Singh B, Mielke MM, Parsaik AK, et al. A prospective study of chronic obstructive pulmonary disease and the risk for mild cognitive impairment. JAMA Neurol 2014; 71:581.
- Martinez CH, Richardson CR, Han MK, Cigolle CT. Chronic obstructive pulmonary disease, cognitive impairment, and development of disability: the health and retirement study. Ann Am Thorac Soc 2014; 11:1362.