Will My COPD Progress? What Can I Expect Over The Next Few Years?
Studies Show It Happens In 18% to 36%
Dear Dr. Mahler:
I have read that COPD is a “progressive disease.” Does this mean that my breathing and overall condition will get worse? It would be helpful to know this in order to make plans with my family and about my finances.
Except for my “severe” COPD (according to my lung doctor), I am otherwise healthy. I take two different inhalers and go to maintenance pulmonary rehabilitation at the local hospital 2-3 times a week. Also, I try to eat healthy foods.
Thanks for any information – good or bad.
Bill from Newburgh, NY
Dear Bill:
Your question is quite common. I am asked about possible COPD progression frequently in my practice as many individuals assume that “It will get worse.”
Hopefully, the following information will be somewhat reassuring.
First, progression of COPD is typically determined by changes in lung function over time. This is usually measured by the amount of air exhaled in one second (called FEV1).
Second, it is important to understand that there is normal decline in FEV1 as we age. The decline starts at about age 40 years. This decline is due to loss of elastic fibers in our lungs just as we lose elastic fibers in our skin – causing sagging. In general, the average decline in FEV1 for men is 30 ml/year due to aging.
Pie charts on progression of COPD based on changes in FEV1 over time. Each pie chart represents a different study with the name of the first author below the chart. The red areas reflect the percentage of rapid decliners. The range is 18% – 36% for “rapid decliners.” From Celli. Chest 2018; volume 154; page 1404.
In a review article, Dr. Celli addresses your question, “Will my COPD progress?” The figure shown above describes the changes in FEV1 over time in three different studies. The observation time periods (F/U = follow-up) ranged from 3 to 10 years.
The blue areas show that 50% to 82% of individuals with COPD had a normal, or expected, decline in FEV1 due to aging. The gray areas show those who actually improved. The red areas show that 18% to 36% are “rapid decliners” – meaning that their FEV1 declined greater than expected with aging.
How will you know if you are one of those 18% to 36% whose COPD is “getting worse?” You should ask you lung doctor to show you the results of your breathing tests (PFTs). It will be important to view results over at least 3 years to answer your question.
Bill – It is also important to realize that COPD “flare-ups” can lead to a more rapid decline in lung function. Obviously, no one wants to get sick. You should do whatever you can to prevent chest infections (flu and pneumonia vaccines and continue to participate in pulmonary rehabilitation) and to avoid inhaling “bad air” – such as fumes, dust, air pollution, etc. Also, not smoking or quitting smoking is quite important to slow worsening.
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.