Chest
Volume 121, Issue 5, May 2002, Pages 1434-1440
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Clinical Investigations
Copd
Dyspnea Is a Better Predictor of 5-Year Survival Than Airway Obstruction in Patients With COPD

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Background

FEV1 is regarded as the most significant correlate of survival in COPD and is used as a measure of disease severity in the staging of COPD. Recently, however, the categorization of patients with COPD on the basis of the level of dyspnea has similarly been reported to be useful in the prediction of health-related quality of life and improvement in exercise performance after pulmonary rehabilitation.

Study objectives

We compared the effects of the level of dyspnea and disease severity, as evaluated by airway obstruction, on the 5-year survival rate of patients with COPD.

Design and methods

A total of 227 patients with COPD were enrolled in a 5-year, prospective, multicenter study in the Kansai area of Japan, involving 20 divisions of respiratory medicine from various university and city hospitals.

Results

After 5 years, 183 patients were available for the follow-up examination (follow-up rate, 81%). The 5-year cumulative survival rate among patients with COPD was 73%. The effect of disease staging, based on the American Thoracic Society (ATS) guideline as evaluated by the percentage of predicted FEV1, on the 5-year survival rate was not significant (p = 0.08). However, the level of dyspnea was significantly correlated to the 5-year survival rate (p < 0.001). The Cox proportional hazards model revealed that the level of dyspnea had a more significant effect on survival than disease severity based on FEV1.

Conclusions

The categorization of patients with COPD on the basis of the level of dyspnea was more discriminating than staging of disease severity using the ATS guideline with respect to 5-year survival. Dyspnea should be included as one of the variables, in addition to airway obstruction, for evaluating patients with COPD in terms of mortality.

Section snippets

COPD Case Registration

Case study meetings were held from October 1990 to February 1994 (eight meetings in all). We had asked participating physicians to mail the results of individual case examinations in advance and then distributed them to the participants at the meeting. Ten to 20 chest physicians from a total of 20 facilities participated in each meeting. Each facility presented its case with chest radiographs and CT scans of the patients. During the meeting, clinical, physiologic, and radiographic features were

Results

The characteristics of the 227 patients with COPD registered in the study are summarized in Table 1. The male to female ratio was approximately 9:1. Only two patients (0.8%) had never smoked. Symptoms of chronic bronchitis were considered to be present in 132 patients (58%). All patients had a wide range of airway obstruction.

Of the 227 patients enrolled, 183 patients were available for the follow-up examination (follow-up rate, 81%). Participating institutions declined to cooperate in 24

Discussion

This multicenter prospective study demonstrated that categorizing patients with COPD on the basis of the level of dyspnea was more closely correlated with survival than classification on the basis of disease severity as assessed by the percentage of predicted FEV1. Studies on the prognosis of patients with COPD have utilized various objective indexes as factors related to survival. The present study suggests that categorization by the level of dyspnea may be similarly useful in the prediction

ACKNOWLEDGMENT

This report represents a joint study involving longitudinal surveys conducted by the following medical institutions in Japan: Shizuoka City Hospital (Dr. T. Hirata), Third Department of Internal Medicine of Fukui Medical University (Dr. T. Ishizaki), Kyoto First Red Cross Hospital (Dr. M. Nakayama), Department of Respiratory Medicine of Graduate School of Medicine (formerly the Chest Disease Research Institute) of Kyoto University (Drs. A. Niimi and K. Nishimura), Tenri Hospital (Dr. K. Tomii),

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    Financial support provided by Glaxo Wellcome K. K. in Japan.

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