NetWellness has received many questions regarding prognosis and life expectancy for persons with COPD and emphysema. Although it is not possible to provide specific predictions in a forum such as this, the following guidelines may be helpful in knowing what to expect.

For more specific expectations and suggestions, you may want to contact a pulmonologist. Pulmonologists are physicians who specialize in lung diseases. A pulmonologist can comprehensively evaluate your condition, answer your questions about life expectancy, and ensure that you are being treated in the best manner.

Stages

Emphysema, also known as COPD, is a chronic condition with multiple factors that impact survival and life expectancy. Stages of COPD are generally defined using the GOLD criteria (Global Initiative for Chronic Obstructive Lung Disease). It has four levels or stages:

• mild – or Stage 1

• moderate – or Stage 2

• severe – or Stage 3

• very severe – or Stage 4

These stages are determined from breathing tests, known as Pulmonary Function Testing (PFTs), which show obstruction (Spriometry-FEV1/FVC ratio of less than 70 percent) and how much air a person can exhale in one second. You can find more information about the stages of COPD at http://www.goldcopd.com/.

Lack of activity tolerance and increasing shortness of breath can be seen in the end stages. Some people lose weight as just the work of breathing burns up all the calories they consume. Most will require oxygen. There may be more potential for developing acute bronchitis or pneumonia; this is why it is so very important that all patients with emphysema have a pneumonia vaccine and a yearly flu shot.

Patients with severe disease frequently develop cough, phlegm production, and shortness of breath. As the disease progresses, these symptoms get worse and patients often develop fatigue and weakness. An acute exacerbation (worsening of above symptoms) can occur with minimal warning. This can be triggered by viral or bacterial lung infections, pollution, or unknown causes.

Generally, when people require oxygen they are classified as Stage 4, which includes chronic respiratory failure. People who have low oxygen levels in the blood and need to wear oxygen usually fall into the category of chronic respiratory failure.

Life Expectancy

Some information is available on prognosis in COPD patients, but it is limited. Traditionally, prognosis has been reported based on the FEV1, which is a part of PFT. An FEV1 of less than 35 percent of predicted means very severe disease and some studies estimate that more than half of patients with very severe disease may not be expected to survive for four years.

In addition to the FEV1, other factors that predict prognosis are

• the person’s weight (very low weight is bad in this case),
• the distance walked in six minutes, and
• the degree of shortness of breath with activities.

These factors are called the BODE index and can be used to provide information on prognosis for one-year, two-year, and four-year survival. For example, a person who has lung impairment with an FEV1 of 20%, shortness of breath when getting dressed, and the ability to walk only 500 feet in six minutes has a two year survival rate of 69 percent. Based on studies, 31 out of 100 similar people will not survive two years

Expected survival for individuals cannot be determined in this forum, but important questions to ask your physician or health care provider might include the following:

• How severe is your COPD based on pulmonary function tests (what is your forced expiratory volume in 1 second [FEV1])?
• Do you have higher than normal carbon dioxide levels?
• Are you using oxygen?
• How short of breath are you–at rest? –with mild activity? –with higher levels of activity?
• Can you walk very far or are you limited to a chair or bed?
• Have you ever participated in pulmonary rehabilitation?
• How is your weight? Are you very thin?

Improving Survival

Smoking cessation is the most important treatment in COPD and improves survival. Oxygen therapy has been shown to improve survival if a patient has low oxygen levels. Pulmonary rehabilitation, while not shown to improve survival overall, does dramatically improve activity tolerance and, therefore, quality of life.

For more information:

Go to the COPD (Chronic Obstructive Pulmonary Disease) health topic.