Prognosis

One cohort study [14] has shown that predictors of increased mortality in COPD include:

• Increasing age
• Significant co-morbidity
• Decreasing post bronchodilator FEV₁
• Those patients already on long term oxygen therapy
• Increased number of COPD exacerbations, particularly those with 3 or more episodes
• Increased number of hospital admissions

A further UK audit [15] has shown death in 14% of patients admitted to hospital within 3 months of admission. The most important prognosticators for death in this group were:

• Poor performance status*
• Low arterial pH on admission*
• Presence of bilateral leg oedema*
• Age > 70 years
• Home circumstances, particularly if the patient is in a nursing home
• Unrecordable peak flow on admission
• Pulse oximetry showing oxygen saturation under 86%
• Intervention with assisted ventilation

The 3 marked with * were the 3 major independent predictors of mortality.