Will My COPD Get Worse?
A Common Question
Dear Dr. Mahler:
I recently viewed an on-line video about COPD. One of the experts keep saying that “COPD is a progressive disease.” Is that true?
I see my lung doctor once a year and have breathing tests before each visit. Last month she showed me my test results over the past 3 years. The tests for FEV1 and FVC were quite stable over that time period. She said that I am “maintaining” my lung function probably due to the two long-acting bronchdilators that I take daily.
This is very confusing, and I am sure that others with COPD have the same question and want to know the answer.
Keep posting,
Phil from Glenview, MT
Dear Phil,
Thanks for an important question and one that I am asked frequently by patients in my practice.
To answer it, I provide information about changes in lung function, particularly FEV1 (forced expiratory volume in one second) over time. This is the traditional approach to address thenatural history of COPD, which describes what is expected to happen over time.
In healthy adults, there is loss of elasticity in the lung–the ability to resume normal shape after being stretched–with aging. Because of this loss of lung elasticity, or recoil, the FEV1 normally decreases by about 40 milliliters each year in men and of about 30 milliliters each year in women. This normal and expected decline generally starts between 40 and 50 years of age.
Changes in Lung Function. The top line labeled TR1 (Trajectory 1) shows the normal decline in FEV1 with aging in 71.5% of the study population. Patients with COPD may follow this trajectory as shown in TR4 (Trajectory 4) at bottom of graph.
In contrast, the natural history of COPD is quite variable. There are different rates of decline in FEV1 or possible pathways:
“Normal decliners” –average decrease in FEV1 of 40 milliliters/year in men and of 30 milliliters/year in women–as occurs in healthy individuals due to aging
“Rapid decliners” –average decrease in FEV1 is significantly greater than observed in “normal decliners”–illustrates progression or worsening of COPD
“Improvers” –FEV1 increases over time
Will My COPD Get Worse?
Although it is impossible to predict the trajectory of COPD for any individual, measurement of lung function (breathing or pulmonary functions tests) every 12 months can assess your COPD pathway. Certainly, anyone who continues to smoke cigarettes or inhale airborne irritants frequently will likely decline faster than expected due to aging.
Phil – I have many patients in my practice like you – their breathing tests (FEV1 and FVC) are the same year after year. I like to show them the graphs of their test results to reinforce that their “COPD is stable.” For those who report worse breathing (more shortness of breath), other conditions should be considered including anemia, heart disease, being “out of shape” (deconditioning), and anxiety/depression.
Please note, the advice provided is not a substitute for asking your health care professional about your specific situation.
Sincerely,
Donald A. Mahler, M.D.