COPD: a quarter of patients die within 3 years.

Clinical bottom line (level 2b)

  1. A quarter of patients with COPD are dead within 3 years.
Anthonisen et al: American Review of Respiratory Disease 1986; 133: 14-20
Expires November 2003

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: 5 acute hospitals, USA

985 patients (aged mean 61, 79% male) with COPD (FEV1 < 60%, and FEV1/FVC < 60%) - mean FEV1 36% predicted

Excluded if
  • pO 2 < 55 mmHg on room air
  • total lung capacity < 80% predicted
  • FEV1 response to bronchodilators > 80% predicted or > 75% FVC
  • evidence of other serious disease
  • aged < 30, > 74
  • asthma


    • All patients received theophyllines and beta-agonists. Acute exacerbations with treated with 7 to 10 days courses of antibiotics and severe symptoms were treated with a course of steroids.

    Cox proportional model used to adjust for confounding factors.

    87% followed for mean of 35 months
    Outcomes studied:
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)    		 NNF
    (95% CI)
    death 3 years 228/985 23%
    (21% to 26%)    		 4
    (4 to 5)

    • Mortality was associated with
      • increasing age
      • falling FEV1
      • minimal change in FEV1 following bronchodilators
      • falling total lung capacity
      • increased heart rate at rest
      • physical disability

    Comments

    1. Patients were enrolled in a randomised controlled trial.
    2. No multivariate analysis performed on prognostic factors - the ones reported are not clearly independent.
    3. No hypoxaemic patients were included - these tend to have a worse prognosis (see Home O2 trials)

    Citation

    1. Anthonisen NR, Wright EC, Hodgkin JE, et al: prognosis in chronic obstructive pulmonary disease. American Review of Respiratory Disease 1986; 133: 14-20
    Search Terms: ?
    Contributor: Bob Phillips and Chris Ball, November 1999
    Reviewer: Mitsuhiro Kamei

    Clinical Question.
    Patient COPD
    Intervention or Exposure clinical features, respiratory function
    Outcome death